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Catalyzing Maternal and Child Health Results by Paying for Performance: Evidence from Developing Countries. Catherine Connor and Rena Eichler Health Systems 20/20 Project. 15 November 2010 Health Systems Research Symposium. Feasibility of Insurance Design and Implementation .

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Catalyzing Maternal and Child Health Results by Paying for Performance: Evidence from Developing Countries

Catherine Connor and Rena Eichler

Health Systems 20/20 Project

15 November 2010

Health Systems Research Symposium


What does pay for performance have to do with reaching universal coverage

Feasibility of Insurance Design Performance: Evidence from Developing Countriesand Implementation

Financing options

Pop Coverage

Benefits package

Provider engage-ment

Organiza-

tional structure

Opera-tions

Monitoring and Evaluation

What does pay for performance have to do with reaching universal coverage?

Pay providers for quality or efficiency

Incentives to use priority services

Incentives to cover hard-to-reach populations


Presentation objectives
Presentation Objectives Performance: Evidence from Developing Countries

What is Pay for Performance?

Highlights from on-line survey of country experiences

Expanding access for maternal and child health results: the case of Burundi


What we mean by P4P Performance: Evidence from Developing Countries

Payer

Donars. Govenment, NGOs

Health Programs, Insurers

Funds, Goods, Other

Results

Recipient

Patients or Families

Service Providers (facility or health worker)

NGO or program implementer

Government - Local or National

Demand Side

Supply Side


What is p4p
What is P4P? Performance: Evidence from Developing Countries

Many terms: results-based financing, performance-based financing, performance-based contracting, conditional cash transfers, …

One common definition:

  • “Transfer of money or material goods conditional on taking a measurable health related action or achieving a predetermined performance target” *

    *From the Center for Global Development Working Group on Performance-Based Incentives


Pay for performance p4p an explosion of interest and funding
Pay-for-Performance (P4P) Performance: Evidence from Developing CountriesAn explosion of interest and funding


Why is P4P getting so much attention? Performance: Evidence from Developing Countries

  • Flat salaries for providers leads to low incentives to provide quantity or quality or to serve the poor

  • Fixing incentives is important complement to infrastructure, technical, and capacity building interventions

  • P4P can be combined with any provider payment method: Salary, FFS, capitation, case-based, global budget


Snapshot of p4p country survey
Snapshot of P4P Country Survey Performance: Evidence from Developing Countries

Why do this survey?

To fill the gap between growing experimentation and little documentation

Global online survey 2009

90 e-responses

25 responses summarized

14 longer case studies in 2010


Distribution of 25 cases by region
Distribution of 25 cases by region Performance: Evidence from Developing Countries


Survey results purchasing focused on priority services
Survey results: Purchasing focused on priority services Performance: Evidence from Developing Countries

Maternal health results dominate (22/25).

Child health results also top priority (14/25).

Infectious (e.g. HIV/AIDS, malaria) and non-communicable diseases (e.g. cancer screening, diabetes and asthma management) included but less frequent


Primary care facilities Performance: Evidence from Developing Countries

Rural or peri-urban areas

Community outreach

Demand side (users/patients) - vouchers and transportation subsidies

Increasing attempts to reward quality

Survey results: Designs to expand access


BURUNDI Performance: Evidence from Developing CountriesPublic-private purchasing to increase use of priority services and improve quality


What drove interest in pbf in burundi
What drove interest in PBF in Burundi? Performance: Evidence from Developing Countries

1. Kaneza 2007; 2.http://healthsystems2020.healthsystemsdatabase.org/


P4P Purchasing – how it works Performance: Evidence from Developing Countries

TechnicalAssistance

HealthNetTPO

Cordaid

Community survey

Monthly payments fee for service

+

quarterly bonus for quality

Quality

Assess


Number of women using contraceptive methods doubles
Number of women using contraceptive methods doubles Performance: Evidence from Developing Countries

Burundi Results – Kibuye Province


Using p4p to expand access in developing countries
Using P4P to expand access in developing countries Performance: Evidence from Developing Countries

  • Many different designs

  • Focus on maternal and child health

  • Majority are supply-side (provider)

  • Some are demand-side (user)

  • Clear need for more documentation to learn what is working and learn how design and implementation challenges are being overcome


Thank you

Thank you Performance: Evidence from Developing Countries

Reports related to this presentation

are available at www.HS2020.org


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