The Paris Declaration on Aid Effectiveness (PD), launched in 2005, and the International Health Partnership (IHP+) have promoted a results-based management approach (RBM) to health care based on 6 principles: simplicity, action-based learning, accountability, adaptability, partnership, and transparency. These principles have been implemented in the form of health policies as part of the development and implementation of National Health Sector Strategic Plans. The recent experience of several African countries provides an indication of the strengths and weaknesses of results-based management in the health sector. In Senegal, inadequate training has resulted in inadequate planning, particularly in the development of the Medium-Term Expenditure Framework (MTEF). In its last Health Sector Strategic Plan, Burundi, against all results-based logic, allocated 93 % of its budget to the central level, compared to just 1 % and 6 % respectively to the intermediate and peripheral levels. In Mauritania, the state has not complied with the MTEF, despite the significant increase in the resources allocated to the health sector. By contrast, in Rwanda, there has been a significant improvement in health indicators as a result of the harmonious development of the HSSP and the related MTEF and compliance with the budget. These challenges require an extensive use of RBM through improved governance in the health sector and capacity building.