Universal Health Coverage, to meet the Sustainable Development Goal of ‘Health for All’, aims to increase the access of preventative and curative care services, particularly to the poor and vulnerable. However, the very provision of curative services by health providers in the primary care setting in low-income countries is considered one of the major drivers of antimicrobial resistance.

Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013.

Conditional cash transfer programs are often used to encourage poor families to take young children for regular health check-ups and enroll them in school. Given the proven successes of these programs, development experts and policymakers are turning to cash to promote other health and education goals and evaluating the impact to inform future decision making. Can cash transfers successfully cut transmission of HIV/AIDS by reducing risky sexual behaviors?

Incentive-based policies have been shown to be powerful in many areas of behavior, but have rarely been tested in the sexual domain. The Rewarding Sexually Transmitted Infection Prevention and Control in Tanzania (RESPECT) study is a randomized controlled trial testing the hypothesis that a system of rapid feedback and positive reinforcement that uses cash as the primary incentive can be used to reduce risky sexual activity among young people, male and female, who are at high risk of HIV infection. The study enrolled 2,399 participants in 10 villages in rural southwest Tanzania.

Pay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs’ costs or cost-effectiveness. The authors conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. They reviewed project accounts and reports, interviewed key stakeholders, and derived outcomes from a controlled before-and-after study. In 2012 US dollars, the financial cost of the pay-for-performance pilot was $1.2 million, and the economic cost was $2.3 million.


The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex.


An unblinded, individually randomised and controlled trial.


10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania.

Building awareness for results-based financing (RBF) and on studies about its contextual feasibility and appropriateness is an important activity that can help policymakers to make informed decisions about the use of RBF and its possible design. Another critical— and related— activity is holding stakeholder consultations. These consultations can help to ensure that the design of the RBF program is tailored to local realities. 

In recent years, Performance Based Financing (PBF); a form of result based financing, has attracted global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets.

In Washington
Marshall Hoffman, H&H Washington, +1 703 801-8602 
Nils Hoffman, H&H Video, +1 703 967-1490 
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