Performance-based financing in low- and middle-income countries: still more questions than answers

Nine studies, of which fewer than half had been published in scientific jour-nals, fulfilled our inclusion criteria: one randomized controlled trial (RCT) and two interrupted time series conducted in Asia, and six controlled before–after studies conducted in Africa. Only two outcomes related to health care uti-lization– institutional deliveries and antenatal care– were assessed in more than one trial. Inconsistent results across studies made summarizing and inter-preting the evidence difficult.The most rigorous African study reported a moderate increase in insti-tutional deliveries, from around 35% to 42% (i.e. 7 percentage points; 95% confidence interval, CI: 1–14).