www.kit.nl Final version Executive summary

Performance Based Financing (PBF) is a means of financing health facilities based on results that are measurable and agreed upon in contracts has been introduced by Cordaid in Zambia. In 2007 Cordaid commenced PBF support to five mission hospitals, with one hospital and two health centres added in 2008. This report describes the findings of a formative evaluation undertaken in 2008 to explore the PBF conceptualisation and implementation in Zambia, identify lessons learnt and make recommendations for improvement. The study carried out in Zambia is part of a multi-country evaluation and is not an accountability evaluation. The set up and effects of PBF were studied in four PBF supported mission hospitals (St. Paul’s, Kasaba, Lubwe and Minga) and one Rural Health Centre (Muzeyi) through discussions and semi-structured interviews with relevant stakeholders and the collection and analysis of health and financial data. Recognising that it is difficult to attribute effects to PBF by merely comparing data before and after PBF implementation, several non-PBF facilities wer