Using Supply-side Pay for Performance (P4P) to Strengthen Health Prevention Activities and Improve Efficiency: The Case of Belize

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. The scheme specifically focuses on pre- and postnatal care and deliveries, and primary care for chronic illnesses such as diabetes, hypertension, and asthma. Belize’s National Health Insurance (NHI) administers the P4P scheme and the Ministry of Health determines policies that include defining the packages of services and licensing and accrediting health facilities.
 
This case study describes P4P implementation through the NHI and Social Security Board and offers lessons for countries that are considering implementing similar NHI-led schemes.
 
From the Health System 20/20 P4P 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.