Payment-by-results for health interventions in low- and middle-income countries: A critical review

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Motivation: Payment‐by‐results (PbR) is now an important form of conditionality, whereby donors disburse development aid on achieving a pre‐agreed measure.

Purpose: The article presents a critical review of PbR for health interventions, aiming to draw out lessons about the implementation and impact of PbR in international development programmes.

Approach and Methods: An extensive search identified 81 studies that varied widely in terms of health sub‐themes, geographical regions and methodological quality.

Findings: Employing the Measure‐Agent‐Principal (MAP) framework we find that governments are the dominant principal in most of these studies, and health facilities and individuals the dominant agent; 60% of the evidence reports a wide range of heterogeneous output‐level measures.

Policy implications: We assess PbR in the context of health to better understand whether it is an effective aid‐delivery mechanism more broadly, and find that positive and significant effects dominate. We include evidence maps to highlight research gaps in the PbR literature.
Original languageEnglish
Article numbere12538
JournalDevelopment Policy Review
Issue number1
Early online date6 Dec 2020
Publication statusPublished - Jan 2022


  • aid conditionality
  • aid delivery
  • critical review
  • health
  • payment-by-results

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