Determinants of underperformance in FBR implementation

Results: This study showed that the FBR strategy was perceived by the players involved as having been well integrated into the health system with a view to improving the quality of care and services. On the other hand in addition to the motivation of certified staff limitations were raised concerning the inadequacy of coaching due to the absence of an APP and the demotivation of RECOs due to the non-payment of RECO bonuses. Conclusion: There is ample evidence to support Outcome-Based Financing as an approach to strengthening the health system of a low-income country provided it is implemented from a holistic perspective acting on all pillars namely community participation since RECOs are the actors in RBF performance.