Recommended reading
Can “pay for performance” increase utilization by the poor and improve the quality of health services?
Knowledge, training and supplies not enough to improve health outcomes
Authors:
R. Eichler
Publisher:
Center for Global Development, USA, 2006
This background paper for the Working Group on Performance Based Incentives looks at a particular type of financing intervention to address the joint problems of under utilisation and low quality of health services. The paper focuses on demand and supply side financial and material (e.g. food, travel vouchers) incentives that can be used to improve use and quality of ambulatory health care services, especially for the poor. The authors find that even when providers have the knowledge, skills and necessary inputs (human resources, drugs, equipment, supplies) to produce a sufficient quantity of quality services to meet population needs, there is low take-up, substandard quality, and poor health outcomes throughout the developing world. Even when consumers are aware of health benefits and that the services are physically and financially accessible, they do not necessarily use them.
Pay-for-performance schemes (P4P) are defined as the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. This paper argues that P4P schemes, targeted at both demand and supply sides, can address the underlying barriers and constraints to strong health system performance and have the potential to contribute significantly to improving health outcomes in the developing world.
