Discussion
This study had several limitations. As the reform had been
ongoing for more than 4 years, it was not possible to collect
data at baseline to compare to the post-reform situation. In
addition, Dimensions 1, 3 and 4 in Table 2 are features of
health sector management that are often driven by other sector
strategies and reform processes. In the absence of controls,
there is no way to distinguish the impact of PBB from that of
other sectoral initiatives which may have influenced
performance.