As countries grapple with limited resources and fiscal space to develop their health systems, performance-based financing is a strategy that can effectively tailor health and nutrition service delivery to their population¡¯s needs. Lao PDR has been making impressive use of this strategy under the . In light of this success, a high-level Timor-Leste delegation recently visited to see what valuable lessons could be learned.
Timorese Vice Minister of Health Institutional Strengthening, Jose dos Reis Magno, led the week-long tour from February 9 to 15, 2025. Senior Timorese health and finance officials gained critical insights into the effective implementation of performance-based financing strategies and quality improvement initiatives¡ªincluding quality and performance scorecards¡ªwhich feature under the project.
Co-financed by the World Bank, the Australian government, the Global Fund, and the Global Alliance for Vaccination and Immunization, HANSA works to improve health and nutrition services at the community level through performance-linked payments and reforms whose funding is released only after targeted health outcomes are achieved. It uses quality performance scorecards to assess the readiness and quality of services at primary healthcare facilities. The scorecard system was piloted at community health centers in four Lao provinces in 2021 and saw an average assessment score of 61%. It incentivized better quality service delivery by rewarding health centers that demonstrated improvements in priority programs, such as maternal health and child nutrition. By 2024, when the scorecards were used to grade the performance of all health centers nationwide, the average assessment score had increased to 86%.
Nenik Maria Imaculada Ximenes, Timor-Leste's National Director of Payments and General State Budget Administration, said it was truly inspiring to see how the Lao Ministry of Health leverages technology to improve transparency and efficiency. ¡°What really stood out to me was how Lao PRD is using innovative approaches in financial management, especially its focus on building strong relationships with stakeholders. Performance-based financing helps improve the quality and results of services by encouraging providers to do better and serve more. It also makes sure resources are used wisely by linking funding to actual results, which helps cut down waste. Plus, it promotes honesty and accountability with clear performance goals and motivates health workers with financial rewards to do their best.¡±
The study tour was a collaborative initiative between the Timor-Leste Ministry of Health, the Lao Ministry of Health, the World Bank, and the Australian government. The primary goal was to equip senior Timorese financial officials with firsthand experience and a comprehensive understanding of the performance-based financing model as practiced in Laos.
¡°Overall, the tour gave us some very practical ideas on how we can implement digital systems to make our Treasury functions stronger, rooted in close stakeholder engagement. I¡¯m confident these strategies will help us achieve our goals in Timor-Leste more effectively,¡± said Director Ximenes.
