Send to friendThe muddied motorbike leaning against the wall and the boxes of supplies stacked neatly in the corner are hard to ignore. They take up much of the space in this tiny shed-like room. But this isn’t a factory inventory room, or the home of a traveling salesman. It’s the dwelling place and workspace of a community health worker in Ghana. And the 125 cc off-road bike? It’s just one of the tools of the trade.
Over this past week, the RBF design team has been traveling in Ghana visiting a number of health centers in the Eastern region. We’ve spoken to a range of health care providers, managers, and decision makers: all in an effort to gather valuable insights into ways the provision of preventive and public health services, particularly those that focus on maternal and child health, can be improved through demand and supply side incentive schemes. On one of these trips, we met Pat, the owner of the bike and, more importantly, a community health worker. 
Pat in Ghana
Pat in GhanaPat has been at her post for six years now. There is little she doesn’t know about the 5,000 plus inhabitants of the community she serves. We soon learn that a day in Pat’s life is rarely routine. On some mornings, she and her assistant are out to check up on all newborns in the area; on others, she’s up and about in the local community monitoring the growth and nutrition needs of young children. She also fits in a couple of rounds at the community schools and homes of mothers to conduct health talks. That motorbike comes in pretty handy when she has to dash off at a moment’s notice to assist with an emergency birth delivery. And when the rains come, equipped with her precious supplies, the motorbike helps her navigate impassable roads where most vehicles can’t reach.
With little, Pat has achieved much. To her credit, 85% of the children living within her community have been fully vaccinated, and there were no reported maternal deaths in 2009, which is nothing short of remarkable since Ghana has a high maternal mortality rate. But there are some tough challenges too, and as a Ghanaian myself I know them too well. This health post is one of the better performing ones. Nevertheless, Pat tells us that several child deaths have occurred over the last few years. There are times when she simply can’t reach her patients—the roads are just too bad. Then there are other times when she has to use her own limited personal funds to pay for transportation costs to bring women into health facilities for free ANC and to deliver their babies. Visiting her in that small room, it is easy to see her resources are being stretched to the limit in the face of growing challenges. And like many of the health workers we interacted with during our visit, the items on Pat’s wish list — better working conditions, access to skills training opportunities, and more hands to help keep delivering on the promise of bringing health to the people—need no discussion.
That’s where we hope RBF can make a difference. While it is not a panacea to fix all problems, it is a tool that gives people like Pat the needed performance incentives to help them increase the quantity and quality of preventive and public health services provided in their communities, districts and beyond. It’s also intended to reward Pat’s hard work and ensure that her efforts don’t go unnoticed. That’s why there’s never one RBF design model. Working together with government partners, the RBF design team is steadily piecing together the fabric of what an RBF pilot design would eventually look like in Ghana.
My time with Pat taught me one thing: a little can go a long way when used properly. Applying an RBF mechanism may ensure that the available funds target the health outcomes we need to help save lives, and that’s what it’s all about.
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