BACKGROUND:
Maternal, newborn, and adolescent health (MNAH) outcomes in hard-to-reach island districts such as Kalangala remain suboptimal due to geographic isolation, limited health workforce capacity, frequent commodity stock-outs, and weak accountability mechanisms. Declining donor support and rising health system costs further threaten the sustainability of essential services in Uganda. Results-Based Financing (RBF), promoted by the World Health Organization, links financial incentives to verified performance outputs to improve efficiency, quality, and accountability. Evidence on its effectiveness in island settings remains limited.

METHODS:
A mixed-methods design will be employed. Quantitative data from the Health Management Information System and RBF verification reports will assess trends in antenatal care attendance, facility deliveries, postnatal care coverage, adolescent service uptake, and commodity availability before and after RBF implementation. Descriptive and trend analyses will be conducted. Qualitative data will be collected through in-depth interviews and focus group discussions with health workers, facility managers, adolescents, mothers, and community leaders, and analyzed thematically. Expected Results The study is expected to demonstrate improved utilization and quality of MNAH services following RBF implementation, reflected in increased service uptake, improved availability of essential commodities, and strengthened accountability mechanisms. Health workers and managers are anticipated to report enhanced motivation and improved use of data for decision-making, while community members and adolescents are expected to describe improved access to and trust in health services. Conclusion. Results-Based Financing has the potential to strengthen the sustainability, performance, and perceived quality of MNAH services in hard-to-reach island settings. Sustained impact will depend on continued system strengthening, community engagement, and integration of RBF within broader