LOOK AT THIS IF YOU'RE INTERESTED IN:
Examining the results of performance-based financing based on evidence compiled from over 15 years in nearly 40 countries.
HOW YOU CAN USE THIS MATERIAL:
Country stakeholders engaged in health and immunisation financing can learn important lessons and experiences from the rollout of performance-based financing (PBF) over the past decade to guide health financing into the future, potentially pivoting from performance pay while retaining the elements of direct facility financing, autonomy, transparency, and community engagement.
OVERVIEW:
Improving Effective Coverage in Health: Do Financial Incentives Work? examines financial incentives in the form of performance-based financing (PBF), a package reform that typically includes performance pay to frontline health workers as well as facility autonomy, transparency, and community engagement. The report focuses on the best policies to support effective coverage, a measure that adjusts simple coverage of care with the quality of care provided.
Key Messages:
- Financial incentives or performance pay to frontline health facilities and workers emerged as an innovative means to improve the quantity and quality of health services delivered. This approach to health financing arose from the frustrating status quo of poor health outcomes in low- and middle-income countries despite increased service utilization.
- This report provides new evidence and reviews the existing literature to assess the results from the introduction of such financial incentives.
- The report pays special attention to impacts on effective coverage, a measure that adjusts simple coverage of care with the quality of care provided.
- It asks which constraints to poor quality of care can be addressed by financial incentives for health workers.
- It further asks what has been the impact of such incentives in general on utilization and quality of care.
- Finally, it asks how offering these incentives compares with some key policy alternatives: cash transfers, vouchers, and direct financing of frontline facilities.
- A range of rigorous studies show that performance-based financing (PBF) projects, which include performance pay among other critical features, including transparency and accountability reforms, resulted in gains in coverage but far fewer, if any, improvements in the quality of health services delivered.
- Compared with business-as-usual, PBF projects offer gains of a similar magnitude as those from direct facility financing (DFF) approaches, which transfer equivalent funds and have transparency and accountability reforms as do PBF projects but do not have specific incentives for health workers and the associated monitoring.