Pay for Performance: Improving Maternal Health Services in Pakistan

Pay for performance (P4P) in Pakistan consists of supply-side payments to providers and demand-side vouchers that subsidize the costs of a package of reproductive health care services and transportation for poor women. The aim is to reduce maternal and infant mortality by increasing utilization of antenatal care, skilled delivery, and postnatal care, as well as family planning services. P4P is being implemented within the framework of a social franchise network, Greenstar Social Marketing. Key features of this program include: strategies to reach women who have not previously delivered babies in health facilities and accreditation and training for private provider members of a social franchise network. This case study thus describes an example of a private sector P4P voucher program targeting reproductive health and offers lessons for countries that are considering implementing similar schemes.    

From the Health System 20/20 case study series, which profiles maternal and child health-oriented P4P programs in countries in Africa, Asia, and the Americas, and is intended to help those countries and donors already engaged in P4P to fine-tune their programs and those that are contemplating P4P to adopt such a program as part of their efforts to strengthen their health system and improve health outcomes.