Global Health Action (Dec 2025)

Counter-verification in performance-based financing: key insights from the Côte d’Ivoire experience

  • Joël Arthur Kiendrébéogo,
  • Kouadjo San Boris Bediakon,
  • Jean-Pierre Tsafack,
  • Marin Passerat De Silans,
  • Robert Yao Kouakou,
  • Clovis Kouassi Konan,
  • Sosthène Dougrou,
  • Xavier Lannuzel,
  • Serge Mayaka Manitu

DOI
https://doi.org/10.1080/16549716.2025.2483072
Journal volume & issue
Vol. 18, no. 1

Abstract

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Background Performance-based financing (PBF) is a key health financing reform in many sub-Saharan African countries, with verification being a critical component. Counter-verification, designed to enhance the credibility of verification, remains largely under-documented and under-researched. This study examines the counter-verification activities within Côte d’Ivoire’s PBF program, providing insights into its implementation and challenges. Methods We performed a content analysis of 14 quarterly counter-verification reports spanning from Q4 2016 to Q3 2023, supplemented by brief, informal discussions. Using the READ approach proposed by Dalglish et al., we systematically prepared the materials, extracted and analyzed data, and distilled the findings. Our analysis focused on discrepancies between verified and counter-verified data, identifying and detailing the underlying causes of these inconsistencies. Results Our analysis revealed mixed results when comparing the verified and counter-verified data. While discrepancies decreased over time for some activities, others remained consistent or even worsened. The primary causes of discrepancies included inadequate record-keeping and failure to meet indicator validation criteria. Challenges in retrieving documents for counter-verification were linked to poorly managed physical and electronic archiving systems, as well as a lack of qualified personnel. Furthermore, the audit of administrative and financial procedures, especially regarding invoice issuance and the use of PBF funds, highlighted several shortcomings. Conclusions Counter-verification is a critical component of PBF programs, designed to strengthen confidence in verifications, correct errors or weaknesses through sanctions or recommendations, and prevent misconduct by both providers and verifiers. To optimize its impact, counter-verification must be systematically integrated into the design of PBF programs.

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