As the proverb goes, “necessity is the mother of invention” and Results-Based Financing (RBF) makes such “invention” possible. By shifting the focus of governments and health systems from inputs to results, it provides a fertile ground to change the way business is carried out in the health sector: it facilitates a path from bottlenecks to effective and effi- cient solutions. Context-specific in nature, RBF has been devised in many shapes and forms to respond to the specific needs of countries, regions, communities and peoples. Typically, RBF interventions target beneficiaries (e.g. conditional cash transfers), providers (e.g. performance-based financ-ing) or country governments (e.g. cash on delivery). Most World Bank-financed RBF projects have generally focused on supply-side incentives, leaving stimulation of demand to health facilities. RBF interventions have, however, rarely been as systemic as in The Gambia.

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