@article{fdi:010077484,
  title = {{W}e shouldn't count chickens before they hatch : results-based financing and the challenges of cost-effectiveness analysis},
  author = {{P}aul, {E}. and {B}rown, {G}. {W}. and {E}nsor, {T}. and {O}oms, {G}. and van de {P}as, {R}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{R}esults-based financing ({RBF}) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. {T}o our knowledge, only one cost-effectiveness study of {RBF} in a lower-middle income country has been published in a peer reviewed journal. {T}hat study - in {Z}ambia - concludes that {RBF} is cost-effective, which was then uncritically repeated in an editorial accompanying its release. {H}ere we would like to warn against readily accepting the conclusion of the cost-effectiveness study of {RBF} in {Z}ambia, because its conclusions are not straightforward and could be dangerously misleading, especially for those readers unfamiliar with health economics. {A}fter outlining the results from the {Z}ambia's {RBF} cost-effectiveness study, we point to important methodological issues related to cost-effectiveness analysis, showing how key assumptions produce particular results. {W}e then reflect on how cost-effectiveness is different from efficiency and affordability - which is important, since cost-effectiveness studies often have considerable influence on national health financing strategies and policy priorities. {F}inally, we provide an alternative reading of the evidence on {RBF} in {Z}ambia. {N}amely, when examined from an efficiency point of view, the study actually demonstrates that {RBF} is less efficient than the simpler alternative of providing more resources to health facilities, unconditioned on performance, which will be of most interest to a government with tight budget constraints. {A}s a result, existing claims that {RBF} is cost-effective are overstated, requiring further and more nuanced examination with more adequate research methods.},
  keywords = {{R}esults-based financing ; cost-effectiveness ; low- and middle-income countries ; {ZAMBIE}},
  booktitle = {},
  journal = {{C}ritical {P}ublic {H}ealth},
  volume = {31},
  numero = {3},
  pages = {370--375},
  ISSN = {0958-1596},
  year = {2021},
  DOI = {10.1080/09581596.2019.1707774},
  URL = {https://www.documentation.ird.fr/hor/fdi:010077484},
}