How Haiti Is Rethinking Healthcare Verification – And Cutting Its Estimated Cost by 99%

For years, one of the biggest challenges in Results-Based Financing (RBF) has been the cost of verifying whether the results reported by healthcare facilities actually happened. Paying health facilities for delivering services sounds straightforward. But before releasing those payments, someone has to establish that the services were provided, the patients were real, and the numbers reported can be trusted.

Traditionally, this has involved verification teams travelling to health facilities, inspecting paper registers, reconciling records and checking reported figures against national health information systems. While necessary for accountability, the process is not just tedious but pretty expensive, time-consuming and difficult to sustain – especially when programmes expand across hundreds of facilities throughout the country.

Haiti is now testing a different approach.

Through its RBF 2.0, the Caribbean nation is moving away from routine, labour-intensive verification missions towards a digital system that combines individual patient records, automated data checks, AI-supported verification calls and electronic approvals.

The potential financial implications are significant. A November 2025 evaluation by Shifo Foundation, in collaboration with Unité de Contractualisation (UC) and Haiti’s Ministry of Public Health and Population (MSPP), estimates that the new model could reduce annual third-party verification expenditure by more than 99% at the national scale. Importantly, the estimated reduction in overall operational costs is around 96%.

The problem with traditional healthcare verification

Under RBF 1.0, verification was largely a manual exercise where teams visited healthcare institutions to review patient registers and compare reported services against the national health information system (SISNU.

The World Bank's 2019 Strengthening Primary Health Care and Surveillance in Haiti project document provides useful historical context. It describes the country's earlier RBF arrangements, including the role of independent external verification agencies in checking reported performance before payments were made. However, for a programme operating across hundreds of facilities, this created a substantial logistical and financial burden. The evaluation estimates that annual third-party verification costs under the previous model would reach approximately US$8.26 million across 993 health institutions.

This is where the RBF 2.0 redesign makes a fundamental difference.

Instead of relying on physical visits as the routine means of checking reported results, verification is increasingly built into the digital reporting and payment process.

How does digital verification work?

RBF 2.0 starts with the way healthcare information is collected. It uses Smart Paper Technology (SPT), along with digital data-entry options that capture individual-level patient information. Health workers easily record services using structured forms, which are then scanned and converted into digital records. The system is then able to identify potential errors and allows staff to review and correct them. Each patient receives a unique medical identification number, linking registration details with services received and subsequent visits.

This is of significant importance because verification is no longer beginning with someone travelling to a facility and manually searching through registers. The information needed to validate reported performance is already available within the digital system.

The next step is automated verification.

Under the proposed national costing model, approximately 10% of clients receiving incentivised services are selected through automated sampling. AI-supported calls are used to contact selected clients, with a standard five-minute call duration.

The system also generates electronic records of reporting, verification and approval, creating a traceable trail for every stage of the payment process. And so, in practical terms, verification is now a part of the system – rather than a separate administrative exercise.

What do the numbers tell us?

The evaluation's national-scale cost comparison offers a striking picture of the potential savings.

Under RBF 1.0, estimated annual third-party verification expenditure stands at US$8,258,719. However, RBF 2.0 has the corresponding estimated annual accuracy-verification cost at US$51,823. That represents a reduction of approximately 99.4% in this specific cost category. The overall operational cost comparison is equally significant:

• RBF 1.0: Approximately US$8.76 million annually.
• RBF 2.0: Approximately US$308,445 annually.
• Estimated reduction: Approximately 96%.

These are national-scale estimates, not savings already realised across all Haitian health facilities. They are based on the evaluation’s costing assumptions and experience from the pilot.

Even under alternative scenarios, the cost advantage remains substantial. The report estimates an approximately 95% reduction with higher use of paper-based SPT forms. When additional equipment replacement and internet costs excluded from the baseline are included, the estimated reduction is approximately 87%. The central finding remains: verification does not have to become more expensive simply because a health financing programme expands.

Can lower-cost verification still be reliable?

Cost savings mean little if they come at the expense of data quality. This is perhaps the most important point to ponder for any results-based financing programme. Haiti's pilot offers encouraging early evidence. Implemented in December 2024 across 19 health institutions in the North Department, RBF 2.0 was evaluated using operational data covering December 2024 to September 2025. The assessment found that:

• 95.3% of clients had complete registration information.
• Age was recorded for approximately 99% of registered clients.
• Unique medical identification numbers achieved 99% accuracy.

Comparisons between paper forms and digitised records showed 99% consistency across a sample of 2,280 records.

These findings suggest that digital reporting does support reliable performance verification without depending on extensive physical inspections. The system also improved administrative efficiency. Under stable operating conditions, the complete process from data submission to payment approval took approximately 24 to 35 days, compared with the multi-month delays associated with RBF 1.0.

A bigger lesson for results-based health financing

Haiti's experience speaks to a wider conversation about how governments should finance healthcare. The World Bank's landmark 2022 policy research report, Improving Effective Coverage in Health: Do Financial Incentives Work?, draws on more than 15 years of evidence from nearly 40 countries. One key conclusion is that improvements associated with performance-based financing don't necessarily come from financial incentives alone; transparency, accountability, facility autonomy, and decentralised financing are equally important elements of health system reform.

The World Bank further explores this in its article, Effective Health Care Reform Requires Transparency, Accountability, and Decentralized Financing. That distinction matters.

A strong results-based financing system needs more than a payment mechanism. It needs dependable data, credible verification, transparent financial processes, and information that governments can actually use to improve health services. This is precisely where Haiti's RBF 2.0 approach is attempting to make a difference.

The bigger opportunity is not simply to reduce the cost of checking healthcare results but to make verification a routine, integrated function of health system management rather than an expensive exercise conducted after services have been reported.

For countries considering the future of performance-based health financing, Haiti offers an important lesson: accountability and affordability do not have to compete. With the right digital infrastructure, reliable patient-level data, and well-designed verification mechanisms, governments can spend less on checking results while building a stronger foundation for knowing whether public money delivers what it was intended to.

Ultimately, the success of healthcare financing should not be measured by how much money is spent verifying performance. It should be measured by how confidently governments can establish that the money is making a difference.