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Home Grown Incentives in Katete District. Harrison Mkandawire District Director of Health Katete District. Katete at a glance. Population: 233,582 (CSO-2000) Health centres: 26 One general hospital:1 Trained staff: 86% Number of CBHCP: 2,462 District grant: K406,341.932 MBB District.

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Home grown incentives in katete district

Home Grown Incentives in Katete District

Harrison Mkandawire

District Director of Health

Katete District

Katete at a glance
Katete at a glance

  • Population: 233,582 (CSO-2000)

  • Health centres: 26

  • One general hospital:1

  • Trained staff: 86%

  • Number of CBHCP: 2,462

  • District grant: K406,341.932

  • MBB District

Why we introduced incentives
Why we Introduced Incentives

  • Health Care workers paid salaries that are not linked to output or outcome measure

  • High maternal mortality ratio

  • High infant mortality rate

  • More deliveries taking place at home

  • Focus was on input or processes

  • High CBHCP turn over


  • Results based planning

  • Results based management

  • Participatory Planning

  • District Health system strengthening




  • LWF


The home grown incentive mechanisms
The home grown incentive mechanisms:

  • rewarding institutions for actual not promised performance

  • linking funding to the quantity of outputs or the quality of outcomes rather than inputs

  • using performance indicators that reflect public policy objectives rather than institutional needs

  • designing incentives for institutional improvement, not just maintaining status quo

Why incentives for health workers
Why Incentives for Health Workers

  • Link Incentives to performance

  • Hold them accountable for the results

  • Change their mindset

  • Accelerate the attainment of health related MDGs

Indicators to be attained
Indicators to be attained

  • Institutional deliveries

  • Fully immunised children

  • ITN utilisation

  • IPT Coverage

  • Pit latrine coverage

  • Contraceptive uptake


Incentives for tbas
Incentives for TBAs

  • K100,000 ( Thirty Dollars )

  • Chitenje material

  • Bicycles

Incentives for clients
Incentives for clients

  • Mama kit- those who deliver in the facility

  • Baby Kit for post-natal- 6 days, 6 wks

  • Food for Ante-natal clients and Under five clients

  • Food for clients who attend outreach sessions

Financial incentives for health workers
Financial incentives for Health workers

  • Floating Trophy

  • K1,000,000 for the best performing health centre

  • K800,000 for the facility for achieving the target

Source of funds
Source of Funds

  • 10% community allocation from the district grant

  • 4% replacement of the lost user fees

  • Child health and Maternal Health allocations

  • Community Development Funds

Reorientation of cbhcps
Reorientation of CBHCPs

  • Galvanise efforts towards MNCH

  • Retrained CBHC

  • Use of RDTs at Community level

  • Use of Coartem at Community level

  • Use of Amoxy at Community level

Other innovations
Other Innovations

  • Bicycle Ambulances

  • Community HFRs

  • Transport for the Dischargees from the hospital and the deceased

  • Solar panels for staff houses

  • All centres have motorbikes

  • All centres have HFRs

  • Detached delivery rooms

  • Display of imprest allocation to health centres

  • 100% disbursement of imprest to health centres

Innovations cont
Innovations cont….

  • Motor bikes for all health centres

  • Imprest schedules distributed to Health centres, Health centre chairpersons councillors and Members of parliament

  • K300,000 local retention allowance

  • Collection of school children for the members of staff in hard to reach areas

Management benefits
Management benefits

  • Management latitude

  • Innovativeness

  • Development of teams cohesion

  • Team accountability


  • Increased attendance in health centres


  • Use of the local resources

  • PPP- Dunavant Cotton Company

  • Participatory planning


  • Need to increase the coverage of selected MNCH services to reach the MDG

  • Ineffective incentives faced by both providers and households hinder achievements of health outcomes.