Financial Incentives

In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after. To inform future scale up, this study assessed motivation and satisfaction among these CHWs. [from abstract]

This paper examines wage setting mechanisms for health workers in hospitals across eight different OECD countries. It describes similarities and differences and how fixed or fluid these approaches have been in recent years through health system reforms, labour market dynamics and economic pressures. [from abstract]

The study sought to investigate the factors contributing to the high turnover of clinical staff at two Catholic Health Services (CHS) hospitals of Andara and Nyangana in the Kavango region of Namibia. The conceptual framework, factors related to the decision to stay in or leave rural and remote areas, was adapted from Henderson and Tulloch (2008) and guided this study. [from abstract]

This report combines findings from a desk review,a mapping of [Close-to-Community] CTC providers and data collected during qualitative explorations carried out in two selected districts of Maputo Province as part of the context analysis. [from introduction]

Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee’s intention to stay. [from abstract]

The pap er studies the effects of a financing mechanism for the health sector in which governmental payment to health facilities is contingent up on the number of patients for some predetermined health services, as opposed to a fixed payment. [from abstract]

This article analyses (1) how financial incentives (salary top-ups) and non-financial incentives (housing and education) affect nurses’ willingness to work in remote areas of Tanzania and (2) how the magnitude of the incentives needed to attract health workers varies with the nurses’ geographic origin and their intrinsic motivation. [from abstract]

Specifically this study aimed to examine the profile of the QHRSS-AH recipients from 2000 to 2010 including graduate recruitment outcomes and retention within the scholarship program. It also explored the influence of the QHRSS-AH on early career practice location decisions and the features of the scheme that influenced motivation to be involved as either a scholarship holder or manager, perceived barriers to employment of scholarship holders in rural or remote services, experiences of scholarship holders as new graduates in rural and remote services and views on support requirements.

This paper presents a framework for assessing the interactions between performance-based financing (meaning performance-based incentives are earned by service providers) and health systems, focusing on low and middle income countries in order to develop a framework for monitoring and evaluating health system reforms in general. [adapted from author]

This review highlights the key strengths and weaknesses associated with performance-based funding (PBF) schemes in their use in low- and middle-income countries. It illustrates the theoretical thinking behind PBF implementation. It also seeks to draw out analysis of the role of African actors in global health diplomacy and decision-making surrounding PBF. [from summary]

This protocol outlines a controlled before and after study that will examine the effect of a pay-for-performance incentive program on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. [adapted from abstract]

The article draws on a policy implementation framework to analyse the implementation of occupation-specific dispensation (OSD), a financial incentive strategy to attract, motivate, and retain health professionals in the public health sector, and seeks to determine whether the manner in which OSD was implemented caused unintended negative consequences. [from author]

The authors describe the design of a cluster-randomized controlled study to investigate the role of sustainable institutional incentives to improve management of malaria in peripheral health facilities. This study will demonstrate whether facility-based rather than individual incentives are compelling enough to change provider behavior and whether these incentives lead to cost savings as a result of targeted drug consumption. [from author]

This chapter surveys experience with performance pay in developing country health programs focusing on four key conceptual issues: what to reward, who to reward, how to reward, and what unintended consequences might performance incentives create. [adapted from abstract]

The authors evaluate Autstralia’s Practice Incentives Program which aims to encourage continuing improvements in general practice through financial incentives to support quality care, and improve access and health outcomes for patients. [from introduction]

This report outlines and evaluates a pay-for-performance program designed to strengthen the role of primary health organizations to focus on population health and health inequality programs, and to address problems of service access and lack of coordination between providers. [adapted from introduction]

This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. [from abstract]

The authors reviewed provider payment methods used in community-based insurance (CBI) in developing countries and their impact on CBI performance. [from abstract]

Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. This article reviews provider payment methods used in CBI in developing countries and their impact on CBI performance. [from abstract]

Health user fees were introduced in Zambia at the beginning of the 1990s with the objective of improving staff motivation. In 2006, they were removed in view of the poverty levels in the country, the high cost for accessing health services, and the desire to provide universal access. This article examines the perspectives of health workers on the change in policy. [adapted from author]

This article addresses health workers’ experiences with the open performance review and appraisal system (OPRAS) in Tanzania, expectations towards pay for performance, and how lessons learned from OPRAS can assist in the implementation of pay for performance. The broader aim is to generate knowledge on health workers’ motivation in low-income contexts. [adapted from abstract]

This brief outlines the concept of performance-based incentives (PBI) in the health sector, facilitating the design of these incentive programs using the case of Senegal as an example, building the evidence for PBI and integrating PBI into strengthening efforts. [adapted from author]

This paper investigates whether governments in developing countries can retain skilled health workers by raising public sector wages using sudden, policy-induced wage variation, in which the Government of Ghana restructured the pay scale for government health workers. [adapted from abstract]

This case study explores the process between donors and the government of moving pay for performance (P4P) from concept to design to implementation. It describes key areas of disagreement, and highlights the political tensions inherent in translating high-level interest in P4P into on-the-ground action. [from author]

The objectives of this paper are to provide an overview of pay-for-performance schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. [from abstract]

This article presents the results of an evaluation of a project in Pakistan to contribute to learning about the design and implementation of pay-for-performance systems and their impact on health worker motivation. [adapted from abstract]

This study details the perceived benefits, problems, and risks of abuse of per diems and allowances in developing countries. Drawing on 41 interviews with government and nongovernmental officials in Malawi and Uganda the report highlights how practices to maximize per diems have become a defining characteristic of many public institutions and influence how employees carry out their work. As per diems have become de facto top ups of salaries, more fundamental reform of health worker incentives and payment is also needed. [from abstract]

Pay for Performance (P4P) programs, based on provision of financial incentives for service quality, have been widely adopted to enhance quality of care and to promote a more efficient use of health care resources whilst improving patient outcomes. The aim of this paper is to evaluate whether it is possible to implement P4P programs in the Lombardy Region, in Italy, based on the existing data set. [from abstract]

While per diems appear to have been originally used to compensate for the loss of time and income caused by such participation, today they have become political instruments that taint research and intervention activities. The author believes per diems are contributing to expected failure of Africa to meet the Milliennium Development Goals by 2015 because they reduce the potential effectiveness of interventions and dilute health sector resources. [from author]

The objective of this study was to assess the influence of loan repayment and other factors on the recruitment and retention of healthcare providers in rural Colorado, USA, and to compare the motivations and attitudes of these rural providers with their urban counterparts. [from introduction]