Incentives

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 paper presents a summary of a regional program on incentives for health worker retention. The studies sought to investigate the causes of migration of health professionals, the strategies used to retain health professionals, how they are being implemented, monitored and evaluated, as well as their impact, to make recommendations to enhance the monitoring, evaluation and management of non-financial incentives for health worker retention. [from summary]

The Ministry of Health, in partnership with CapacityPlus, conducted a discrete choice experiment survey among current students in health training programs as well as health workers practicing in rural districts to investigate preferences for potential attraction and retention strategies. The results constitute an important input to the policy-making process related to the identification, costing, and selection of possible retention interventions for implementation. [from publisher]

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]

This study reportw changes between 2006 and 2008 in numbers and employment status of health staff in three districts of Indonesia following the central government decision to offer doctors, nurses and midwives on contract the chance to convert to permanent civil service status. [adapted from abstract]

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]

The article describes CapacityPlus’s rapid retention survey tool for determining the relative importance health workers place on characteristics related to their choice of employment. This will allow human resource maangers to rapidly assess retention preferences to better pinpoint the incentives and interventions that would most cost-effecively motivate health workers to take up posts in underserved facilities. [adapted from abstract]

A case-control, quasi-experimental study was designed to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. [from abstract]

This paper reviews reports on maternal, neonatal and child health, as well as HIV care and treatment services that look at program incentives. [from abstract]

Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices, and contextual mediators on these effects. [from abstract]

Through in-depth interviews and focus group discussions, this study explores the potential efficacy of non-financial incentives (NFI) proposed by the L10k project, an Ethiopian health extension project. The results of the study outline factors motivating voluntary community health workers, indicate other NFI mechanisms for consideration, and suggest programmatic recommendations. [adapated from publisher]

This case study provides an example of a broad public sector pay for performance approach that incorporates intergovernmental transfers in a decentralized context with rewards for concrete health results at the facility level and the challenges of moving from design to implementation. [from author]

This case study thus describes an example of a private sector pay for performance voucher program targeting reproductive health and offers lessons for countries that are considering implementing similar schemes. [from author]

This case study presents the initial results of the pay-for-performance (P4P) experience of UNIMED-Belo Horizonte, a private, nonprofit organization in Brazil and provides an example of private sector P4P to improve service quality and efficiency. [from author]

This review shows how lessons that have been learned from international experiences have been improved further in China by realignment of the incentives for providers towards prevention and primary care, and incorporation of a treatment protocol for hospital services. [from summary]

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. [from abstract]

Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. [from abstract]

This book explores a new approach to health funding, the transfer of money or goods to patients or providers when they take health-related actions or achieve performance targets. It documents a host of experiences with incentives for maternal and child health care, tuberculosis, child nutrition, HIV/AIDS, chronic conditions and more. [from publisher]

Pay for performance (P4P) is an innovative approach that explicitly links financial investment in health to health results. However, the mechanics of its implementation need to be planned very carefully to elicit the desired behavior change in a given country. This guide offers the reader a systematic framework to document and structure a P4P initiative. [adapted from foreword]

This paper presents data on the remittances sent by migrant nurses to their families back home. It gives voice to the experiences of migrant nurses and illustrates the financial obligations they maintain while working overseas. [from abstract]

This article assesses the potential impact of financial incentives in alleviating health worker shortages in underserved areas through contracting future health workers to work for a number of years in an underserved area in exchange for a financial pay-off. [adapted from author]

Health worker shortages are one of the main constraints in achieving worldwide population health goals. Financial-incentive programs for return of service can alleviate local and regional health worker shortages through a number of mechanisms. This article draws on studies of financial-incentive programs and other initiatives with similar objectives to discuss management functions that are essential for the long-term success of financial-incentive programmes. [adapted from abstract]

There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. [adapted from abstract]

Nepal’s Safe Delivery Incentive Programme (SDIP) was introduced nationwide in 2005 with the intention of increasing utilisation of professional care at childbirth. It provided cash to women giving birth in a health facility and an incentive to the health provider for each delivery attended, either at home or in the facility. We explored early implementation of the programme at the district-level to understand the factors that have contributed to its low uptake. [from abstract]

This video, produced by the Center for Global Development, outlines the case for a new metthod of disbursing donor contributions for global health called Performance-Based Incentives (PBI). PBI aims to boost global health by basing donor contributions on performance and permitting developing countries health systems to determine how to disburse these incentives. [from publisher]

Rwanda is one of the pioneers of performance-based financing. Building on lessons from three donor-financed pilots, the government has assumed leadership for this approach and is scaling up a standardized model nationwide. [from author]

The study used a literature review and field research to obtain data on strategies for the retention of health workers in various institutions in Kenya.

This study undertook an in-depth exploration of the unintended consequences of pay-for-performance programs In England and California. The authors interviewed primary care physicians in California and England and compared unintended consequences in each setting. [adapted from abstract]