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Performance-based financing in Borana

Project Health System Strengthening
Borana -

Performance-based financing (PBF) has been working to strengthen local civil society partners and communities’ capabilities to implement the most appropriate and affordable health system strengthening interventions in Borana since 2015. Cordaid Ethiopia aimed to test PBF as an approach to increase the quantity, quality and accessibility of health care in the remote area of Borana.

Initially, one hospital and eight health centers located in four woredas of the Borana zone participated. This first project phase ran until mid-2018. Based on the initial success, the project was extended into second and third phases. Currently, the number of facilities covered PBF includes 44 health centres and 4 hospitals in Borana zone.

Oromia Region/Borana
Government of the Netherlands – Ministry of Foreign Affairs
Thematic Area
Health Care
Project Duration
01/01/2020 – 31/12/2022
Sustainable Development Goals
Good health and well-being

PBF works towards improving patient satisfaction in the use, accessibility and quality of health care services. Moreover it stimulates a motivated, professional, patient oriented and compassionate health workforce in the community. This approach enhances transparency and accountability within the health care service providing facilities as it allows them to use the available funds in the most cost-effective ways.

Project objectives

1. Improved health service delivery, which can be reflected in increased utilisation of good quality services and increased equity in access to those services.

2. Improved governance of health service delivery through increased capacity at the level of woreda health offices and zonal health department and provide supportive supervision and institutionalization of PBF in the Ethiopian health system.

3. Enhanced health information system that supports data-based decision making at woreda, zonal and regional levels and additional financing potential for the health system through enhanced transparency.

A nurse is assisting a pregnant woman, who is about to deliver at the clinic.
Photo: Petterik Wiggers/Hollandse Hoogte

Target beneficiaries

Through 44 health centres and 4 hospitals, PBF targets over 750,000 people in Borana.


In Borana, the average score for health centers increased from 57% in December 2019 to 72% in June 2021, while there was an increase from 67% to 80% in hospitals during the same period. Proportion of men and women of age, who registered in the long-term or permanent family planning methods in hospitals and health centers has also increased from 39% in July 2019 to 99% in June 2021. 

Moreover, the proportion of registered women going to hospitals and health centers for skilled deliveries whose records were correctly documented has shown increment, from 31% in July 2018 to 98% in June 2021.  The proportion of correctly documented records of women attending first antenatal care visit before 16 weeks of gestation also increased from 34% to 99% during the same period.