New Zealand: Primary Health Organization (PHO) Performance Program

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]

Using Performance Incentives to Improve Health Outcomes

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]

Provider Payment in Community-Based Health Insurance Schemes in Developing Countries: A Systematic Review

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

How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas: A User Guide with Case Studies

This guide aims to provide easy-to-read information and step-by-step advice on a quantitative research method that can help identify appropriate policy responses to health workforce shortages in remote and rural areas. It uses two case studies to illustrate the challenges and the ways to overcome them in conducting the work. [from author]

Cost-Effectiveness Analysis of Human Resources Policy Interventions to Address the Shortage of Nurses in Rural South Africa

Recent policy recommendations have called for increased research efforts to inform the design of cost-effective interventions to address the shortage of health workers in rural areas. This paper takes forward the recent use of discrete choice experiments to assess the effects of potential incentives to attract nurses to rural areas. [from abstract]

Job Preferences of Nurses and Midwives for Taking Up a Rural Job in Peru: A Discrete Choice Experiment

A discrete choice experiment was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru to assess factors that would attract short-term contract nurses and midwives to work in a rural area of Peru. [adapted from abstract]

Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers

This toolkit is intended to allow human resources managers to determine health professionals’ motivational preferences for accepting and remaining in posts. The toolkit builds on the WHO global policy recommendations for rural retention and is based on the discrete choice experiment, a powerful research method that identifies the trade-offs health professionals (or other types of workers) are willing to make between specific job characteristics and determines their preferences for various incentive packages, including the probability of accepting a post in a rural health facility.

Designing Evidence-Based Incentives to Attract and Retain Health Workers Using the Rapid Retention Survey Toolkit

This free online course, developed by the HRH Global Resource Center and CapacityPlus, is based on the Rapid Retention Survey Toolkit. This course will orient participants on how to use a rapid discrete choice experiment methodology to design evidence-based incentives to attract and retain health workers in rural and remote areas. [from publisher]

Provider Payment in Community-Based Health Insurance Schemes in Developing Countries: A Systematic Review

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 Worker Perspectives on User Fee Removal in Zambia

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]

Performance Improvement Recognition: Private Providers of Reproductive Health Services in Peru

While pay-for-performance incentives are frequently used in human resource management programs, there is less knowledge of alternative incentives for recognizing provider achievements in improving quality—especially in the private health sector. This report identifies which types of recognition mechanisms private providers prefer and provides recommendations for Peru and other countries on implementing a quality improvement program with a recognition component. [from abstract]

Working Conditions of the Health Workforce in Nepal

This report examines working conditions of health workers in Nepal in relation to income and incentives, work supplies and equipment, issues on safety and security and the role of local authorities and the community. [from summary]

Policy Options to Attract Nurses to Rural Liberia: Evidence from a Discrete Choice Experiment

A discrete choice experiment was used to test how nurses and certified midwives in Liberia would respond to alternative policies being considered by the ministry of health and social welfare to predict the share of nurses and certified midwives who would accept a job in a rural area under different schemes. [from abstract]

Assessing Performance Enhancing Tools: Experiences with the Open Performance Review and Appraisal System (OPRAS) and Expectations Towards Payment for Performance (P4P) in the Public Health Sector in Tanzania

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]

Tapping into the Potential of Performance-Based Incentives

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]

Wages and Health Worker Retention in Ghana: Evidence from Public Sector Wage Reforms

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]

Preferences for Working in Rural Clinics among Trainee Health Professionals in Uganda: A Discrete Choice Experiment

This study investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda to elicit preferences for attributes of potential job postings they were likely to pursue after graduation. [adapted from abstract]

Health Worker Preferences for Community-Based Health Insurance Payment Mechanisms: A Discrete Choice Experiment

Although a community-based health insurance scheme (CBI) was introduced in Burkina Faso, coverage has remained low and dropout rates high because health workers are dissatisfied with the provider payment mechanism. This research was used to examine CBI provider payment attributes that influence healthcare workers’ stated preferences for payment mechanisms. [adapted from abstract]

Performance Incentives in Provider Purchasing and Contracting Arrangements: Rationale and Experiences

The paper describes performance-based incentive contracting schemes that have been implemented to improve results for a range of interventions from time-limited immunizations to chronic conditions that require significant lifestyle changes, such as diabetes. It argues that performance incentives are a viable and potentially more powerful solution than typical inputoriented approaches to dealing with underutilization, poor quality, and low efficiency. [from publisher]

Pay for Performance (P4P) to Improve Maternal and Child Health in Developing Countries: Findings from an Online Survey

This paper provides a detailed analysis of the complete responses from an online survey to capture developing country experience with pay for performance - a strategy that is increasingly being introduced with the goal of improving maternal and child health outcomes. [adapted from author]

Searching for Common Ground on Incentive Packages for Community Workers and Volunteers in Zambia

This study reviews experiences and lessons learned regarding monetary and non-monetary incentives for community workers. It includes indicative costings and recommendations for further policy and development with regard to the effective recruitment, training and deployment of community workers in Zambia. [adapted from summary]

Institutions for Health Care Delivery: A Formal Exploration of What Matters to Health Workers

Using qualitative data from Rwanda, this study focuses on four institutional factors that affect health worker performance and career choice: incentives, monitoring arrangements, professional norms and health workers’ intrinsic motivation. It also provides illustrations of three institutional innovations that work, at least in the context of Rwanda: performance pay, the establishment of community health workers and increased attention to the training of health workers. [adapted from introduction]

Health Worker Preferences for Job Attributes in Ethiopia: Results from a Discrete Choice Experiment

This paper estimates the effectiveness of a range of policy interventions aimed at improving the supply of health workers to rural areas in Ethiopia. Using data from a survey of 861 health workers, it employs stated preference techniques to predict labor market responses of doctors and nurses to changes in rural wages, working conditions, housing bene…ts, and training opportunities. [from abstract]

Creating Incentives to Work in Ghana: Results from a Qualitative Health Worker Study

This study carries out a microeconomic labor analysis of health worker career choice and of job behavior. It shows how common problems related to distribution or performance of HRH are driven by the behavior of health workers themselves and are determined largely by select monetary and nonmonetary compensation. [from abstract]

Pay for Performance in Tanzania

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]

Performance Incentives for Improved Maternal Health: Experiences, Challenges, Lessons

This document analalyzes the effectiveness of performance incentive schemes in developing countries that comprise maternal health components, including family planning. [adapted from author]

Toward Development of a Rural Retention Strategy in Lao People’s Democratic Republic: Understanding Health Worker Preferences

This technical report presents the results of a discrete choice experiment (DCE) conducted by the Lao People’s Democratic Republic Ministry of Health, in partnership with the World Health Organization and CapacityPlus, using CapacityPlus’s rural retention survey toolkit. The DCE surveyed health professional students and health workers practicing in rural provinces to investigate their motivational preferences for potential strategies to increase attraction and retention in the country’s rural and remote settings. [from publisher]

Access to Non-Pecuniary Benefits: Does Gender Matter? Evidence from Six Low- and Middle-Income Countries

There is an accumulating body of evidence on gender differences in health workers’ employment patterns and pay, but inequalities in access to non-pecuniary benefits between men and women have received little attention. This study investigates empirically whether gender differences can be observed in health workers’ access to non-pecuniary benefits across six low- and middle-income countries. [from abstract]

For Money or Service? A Cross-Sectional Survey of Preference for Financial Versus Non-Financial Rural Practice Characteristics among Ghanain Medical Students

The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana including salary, infrastructure, management style, and contract length in considering future jobs. [from author]

Pay-for-Performance in Disease Management: A Systematic Review of the Literature

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]