The current outbreak of the COVID-19 virus has severe implications for health systems all over the world. This is even more true for lower and middle income countries (LMICs), which generally have weaker health surveillance and health systems, and may therefore carry the heaviest burden. In recent decades, many of these countries have adopted Results Based Financing (RBF) mechanisms as part of their broader health system strengthening and health governance efforts. Such RBF programs, too, are currently under strain as a result of the pandemic. At the same time, the RBF approach, thanks to its adaptability and its systemic nature, may provide an effective framework to embed a specific COVID-19 response into broader and more sustainable system strengthening.