 The study found that while there were improvements in access to essential medicines due to the introduction of performance-based financing, PBF, these improvements were not consistent or sufficient enough to meet the needs of patients. Contextual factors such as a public medicine procurement monopoly, discrepancies and incentives between service provision and service quality indicators, and implementation challenges with payment delays, performance verification, and lack of training in stock management skills contributed to this. Additionally, the study found that other concurrent policies, such as a national user fee exemption for children and pregnant women, also affected the ability of PBF to achieve its goals. This article was authored by Julia Lohman, Stefan Brenner, Jean-Louis Collidiotti, and others.