Author/s: Soeters, Peerenboom, Mushagalusa, and Kimanuka
The experiment found that paying performance-based subsidies to health care providers resulted in comparable or better services and quality of care, supplied at a lower cost, than in control areas that did not use that payment method and also revealed that PBF mechanisms can be effective even in a troubled nation such as the Democratic Republic of Congo.
In this case study, author Cheryl Cashin describes the Quality and Outcomes Framework (QOF) - the UK’s public health care approach that includes voluntary performance-based incentives. QOF is a national program with almost all general practitioner practices participating. In 2009 it covered nearly 100% of registered patients and was designed to promote quality, patient responsiveness, and cooperation with local authorities.
In 1997, the Egyptian Ministry of Health and Population (MOHP) embarked upon a reform program to restructure and reengineer the health sector with the goal of increasing health insurance coverage and access to high-quality health services, and improving health outcomes. As part of the reform, a Family Health Model for service delivery in primary health care facilities was introduced in three pilot governorates (and later rolled out in two additional governorates), and in 2001, pay for performance (P4P) was incorporated into the reform program in all five governorates. Through P4P, health care providers receive a financial incentive, which is distributed to facility staff when they reach certain targets.
Hoima is one of 20 districts in Uganda participating in a pilot project to help poor communities gain access to reproductive health services. The Global Partnership on Output-Based Aid (GPOBA), a partnership program administered by the World Bank, is using output-based aid (OBA) to make access to health services possible. OBA is a results-based approach that ties payment of public funding directly to the delivery of specific services or “outputs”.
Women can buy a voucher which they can use to pay for services at local clinics, including a “safe delivery” package of four ante-natal visits, a delivery attended by a trained medical professional, and one post-natal visit.
Author/s: Susna De, and Rena Eichler, Hailu Zelelew
Ethiopia’s Federal Ministry of Health designed a pay-for-performance (P4P) scheme that has not been implemented. It was intended to improve health care quality and utilization, and thereby the health outcome indicators associated with maternal and child health, family planning, HIV/AIDS, tuberculosis, and malaria, as well as with strengthening the health system.In describing Ethiopia’s experience, the case study provides an example of the design of a broad public sector P4P approach that incorporates intergovernmental transfers in a decentralized context with rewards for concrete health results at the facility level and the challenges of moving from design to implementation.
Author/s: Vikas Dagur, Katherine Senauer and Kimberly Switlick-Prose
This Health System 20/20 case study by Vikas Dagur, Katherine Senauer and Kimberly Switlick-Prose describes the P4P JSY program which consists of supply-side payments to community health workers and demand-side payments to women accessing a continuum of maternal and newborn health services. Focus is placed particularly on poor women and members of scheduled caste/scheduled tribe communities. The JSY program is being implemented in all states, but each state has the authority to adapt and modify the program to best fit its local context.
Author/s: Stephen S Lim, Lalit Dandona, Joseph A Hoisington, Spencer L James, Margaret C Hogan, Emmanuela Gakidou
In the June 5, 2010 Lancet, an independent impact evaluation of India's Janani Suraksha Yojana (JSY) program is highlighted. Findings show that JSY had a significant effect on increasing antenatal care and in-facility births but they also emphasise the need for improved targeting of the poorest women and attention to quality of obstetric care in health facilities.
Author/s: Natasha Hsi, Alix Beith, Michelle Vanzie, and Rena Eichler
Supply-side P4P in Belize consists of monthly capitation payments, discounted based on achievement of monthly performance indicators by contracted public and private primary health care clinics, plus annual performance awards to the clinics. The goal of the scheme is to increase access, improve the quality of services, and enhance the productivity of health care workers. Belize’s National Health Insurance (NHI) administers the P4P scheme
Author/s: Margaret Kilonzo, Katherine Senauer, Kimberly Switlick-Prose, Rena Eichler
This case study provides an example of a voucher program from the viewpoint of an accredited health service providers (MSK) and offers lessons learned for service providers that are considering participation in a voucher program.
This case study explores the process between donors and the government of moving P4P from concept to design to implementation. It describes key areas of disagreement, and highlights the political tensions inherent in translating high-level interest in P4P into on-the-ground action.