Progress made through PBC in Liberia in the post-conflict period is a reason for optimism. Keys to success are strong leadership, good communication among partners, flexible and responsive management. This article highlights the overall design of schemes and lessons learned.
March 2010, Rwandan community health workers, health facility staff, district authorities and Ministry of Health (MOH) representatives gathered in Nyarubaka, a sector in Kamonyi district, for a ceremony inaugurating a new performance-based financing (PBF) program that, along with a new community health worker cooperative incentive program, aims to improve maternal and child health. The program provides incentives to eligible women conditional on meeting up to three targets:
• Prenatal care in the first 4 months of pregnancy,
• Institutional delivery, and
• Postnatal care by mother-child pairs within the first 7 days of birth
In 2003, the Government of Uganda launched a pilot performance-based contracting scheme designed to improve the quality of and access to health services at private not-for-profit (PNFP) health
facilities. In addition to performance incentives, facilities were given freedom to decide how to allocate resources. The latter innovation had a discernible positive impact on health facility performance, but
the former—the incentives—did not. This brief explores the design and implementation issues behind the failure of the incentives and shows that while incentives matter, the success of RBF programs is
not inevitable. They require significant investment (of time AND money) and careful design and implementation. The good news, though, is that enormous improvements can be had for free—by
granting facilities the ability to choose how to spend their money.
This feature article examines the challenges of PBF in Burundi and the ambitious government effort to scale it up across the country, in concert with a major reform - free healthcare for pregnant women and children under five. The pilots were mostly successful and have led to a PBF scheme that also works to ensure equity among vastly unequal provinces and health facilities. The national program is off to a promising start.
This feature article describes how voucher programs for safe motherhood services and management of STIs in Uganda and Kenya are helping improve health outcomes for the poor. Voucher programs take time and investment to design and administer, but the evidence suggests they can increase access to essential services and enable facilities to be more responsive to patients. This article highlights issues of managing claims, accrediting facilities, fraud and sustainable financing.
With more than one million new cases each year, it is the second largest epidemic in the world, behind only India. Poverty helps to spread TB, and TB reinforces poverty, sickening the poor especially in their adult (i.e., most productive) years. Their incapacitation and death are tragedies in themselves but they also contribute to the impoverishment of families, and impact the country as a whole. It is estimated that high-burden countries in Asia suffer from productivity loss due to TB of 4 to 7 percent of GDP per year.¹ But a national TB program incorporating performance incentives has turned the tide on the epidemic.
CCTs play a central role in the anti-poverty strategies of low- and middle-income countries, and at the center of these programs stand some of the world’s neediest women. They are designed to improve the health and education of children, break the intergenerational cycle of poverty, and alleviate immediate economic distress, yet there is often major responsibility for achieving program goals placed on already overburdened women.
A Community of Practice (CoP) for results-based financing (RBF) was launched in February 2010 during a weeklong workshop on RBF in the central African nation of Burundi, as part of the Health Systems for Outcomes (HSO) initiative of the World Bank. One of five virtual CoPs hosted on the HSO website1, the RBF community of practice aims to:
· Cultivate expertise in countries, by identifying local RBF experts, expand their numbers and upgrade their skills;
· Consolidate best practices and identify areas where there are knowledge gaps;
· Organize interactions between researchers and policymakers and inject evidence into RBF policymaking; and
· Connect practitioners and experts in developing countries instead of having donor agencies act as go-betweens.
Sudan has some of the worst health indicators in the world. Malnutrition is widespread, vaccination rates are low, and tropical diseases account for a considerable proportion of the total burden of disease. Performance-based contracting is being tried as a means to spur dialogue between NGOs and the government, and sharpen the focus on results as the public health system rebuilds. Will it work?