Peformance-Based Incentives: Ensuring Voluntarism in Family Planning Initiatives

The trend to implement Performance-based Incentives (PBI) in low- and middle-income countries to strengthen health systems, accelerate service utilization, and enhance quality of health interventions presents an opportunity as well as a challenge for voluntary family planning (FP) service delivery and use. There is considerable opportunity, through PBI, to stimulate quality FP counseling and increase access to and availability of voluntary FP. At the same time, the challenge of introducing incentives that support informed voluntary choice requires careful design and ongoing monitoring. This tension should not cause policymakers to shy away from incorporating FP into PBI schemes, as there is a real danger that excluding FP from the schemes may result in its neglect. Given the central role FP plays in attainment of the Millennium Development Goals, appropriate mechanisms to incorporate FP into PBI approaches are needed.

This paper identifies the opportunities as well as the challenges of incorporating FP into PBI approaches; discusses U.S. policies and support for enhancing access to FP; presents what is known about how low- and middle-income countries are including FP in PBI approaches and lessons learned; and provides suggestions for donors, policymakers, program implementers, and technical assistance providers about how to responsibly and effectively integrate FP into PBI programs in the developing world. By exploring details of a wide range of PBI schemes, this paper looks at how FP has been incorporated, how recipients are incentivized, impact when available, and lessons that hold relevance for other settings.

This paper is 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.