April 7 2011 alex ergo phd broad branch associates
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April 7, 2011 Alex Ergo, PhD Broad Branch Associates. Using Performance-Based Incentives to Enhance the Quality of MNCH Interventions in Developing Countries. The Maternal and Child Health Integrated Program (MCHIP).

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April 7 2011 alex ergo phd broad branch associates

April 7, 2011

Alex Ergo, PhD

Broad Branch Associates

Using Performance-Based Incentives to Enhance the Quality of MNCH Interventions in Developing Countries


April 7 2011 alex ergo phd broad branch associates

The Maternal and Child Health Integrated Program (MCHIP)

  • USAID Bureau for Global Health’s flagship maternal, newborn and child health program

  • Working in well over 30 countries worldwide

  • MCHIP supports programming and opportunities for integration in:

    • Maternal, Newborn and Child Health

    • Immunization, Family Planning, Malaria, HIV/AIDS

    • Water & Sanitation, Urban Health, Health Systems Strengthening


April 7 2011 alex ergo phd broad branch associates

Outline

  • Performance-based incentives (PBI): concept

  • PBI in developing countries: quick overview

  • Incentivizing quality of care: how?

  • What can we learn from high-income countries?


Performance based incentives pbi an umbrella term

Performance-Based Incentives (PBI):An Umbrella Term

“Any program that rewards the delivery of one or more outputs or outcomes by one or more incentives, financial or otherwise, upon verification that the agreed-upon result has actually been delivered.”

Musgrove, Rewards for Good Performance or Results:

A Short Glossary


April 7 2011 alex ergo phd broad branch associates

PBI: A Paradigm Shift in Global Health

“Business as usual” is not enough

Paying for andtrackinginputs

Verifying and paying for results


April 7 2011 alex ergo phd broad branch associates

PBI: A Paradigm Shift in Global Health

PBI is more than a financing mechanism

It is a powerful tool to strengthen health systems


April 7 2011 alex ergo phd broad branch associates

PBI Can Take Many Forms

  • Performance-Based Aid

    Payments to national governments conditional on increasing health outputs or achieving impact

  • Supply-Side Incentives

    Payments to sub-national levels of government, facilities, teams of health workers, or individual providers, conditional on increasing health outputs or outcomes

  • Demand-Side Incentives

    Payments to communities, households or individuals, conditional on engaging in pre-agreed healthy behaviors


April 7 2011 alex ergo phd broad branch associates

On the Supply Side

  • Payments to sub-national levels of government

    e.g. Argentina, Benin, Burundi, Rwanda, Senegal, Tanzania, Zambia

  • Payments to facilities, or teams of health workers

    e.g. Belize, Benin, Burundi, Egypt, Honduras, Rwanda, Senegal, Tanzania, Zambia

  • Payments to service delivery NGOs

    e.g. Afghanistan, DRC, Haiti, Liberia, South Sudan


April 7 2011 alex ergo phd broad branch associates

On the Demand Side

  • Payments to individuals or households conditional on pre-agreed healthy behaviors

    e.g. Brazil, Colombia, Mexico, Nicaragua, Tanzania

  • Vouchers given or sold to individuals redeemable for particular services

    e.g. Bangladesh, Kenya, Nepal, Pakistan, Uganda

  • Incentives to TB patients for adhering to treatment regimen

    e.g. Russia, US


April 7 2011 alex ergo phd broad branch associates

Potential Health Impact

Large scope for increasing utilization AND improving quality in many areas

  • Immunization

  • Nutrition

  • Effective antenatal care

  • Safe deliveries

  • Family planning

  • Malaria prevention and treatment

  • TB detection and treatment

  • HIV prevention and treatment


April 7 2011 alex ergo phd broad branch associates

…But Many Implementation Challenges

  • Weak health information systems

  • Dysfunctional supply chains

  • Poor management capacity at all levels

  • Truly independent external verifiers rare and costly

  • Shortage of well-trained human resources

  • Sustainability – Concerns about how to pay for implementation and financial incentives

    PBI itself may help address some of these challenges


Quality of care definition

Quality of Care - Definition

“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

US Institute of Medicine


April 7 2011 alex ergo phd broad branch associates

Incentivizing Quality of Care: How?

  • Different countries/schemes take different approaches:

    • Incentives linked to the achievement of accreditation

    • Incentives linked to improvements in scores on quality assessment tools

    • Incentives linked to adherence to treatment (demand) or treatment protocols (supply)

    • Incentives linked to ‘quantity’ indicators reflecting a certain level of quality

  • Quality of Care as a carrot or as a stick


April 7 2011 alex ergo phd broad branch associates

Can We Learn From High-Income Countries?

The environments differ in some aspects:

  • Low- and middle-income countries: under-utilization of even the most basic services

  • High-income countries: over-utilization of highly specialized services

    But they are surprisingly similar in other aspects:

  • Wide variations in how providers treat a same diagnosis: poor adherence to standard treatment guidelines

  • Under-utilization of preventive services


April 7 2011 alex ergo phd broad branch associates

Can We Learn From High-Income Countries?

What all countries have in common:

Increased emphasis on incentivizing quality of care


April 7 2011 alex ergo phd broad branch associates

What Can We Learn From High-Income Countries?

  • Incentivizing quality of care in high-income countries – tendency:

    • Incentives linked to maintaining population healthywhile avoiding preventable hospitalization andemergency servicese.g. Accountable Care Organizations in the US

    • Incentives linked to reductions in unnecessary hospital admissions e.g. by refusing to pay for hospital re-admissions


April 7 2011 alex ergo phd broad branch associates

What Can We Learn From High-Income Countries?

  • Incentivizing quality of care is a dynamic process that needs continuous reengineering

  • Smart use of information technology might be a powerful driver

  • Incentives should promote a better coordination between the different levels of care / types of providers

  • Importance of being able to demonstrate what works, how and when


For more information

For More Information…

  • www.RBFhealth.org

  • www.HealthSystems2020.org

  • http://www.cgdev.org/section/initiatives/_active/ghprn/workinggroups/performance


April 7 2011 alex ergo phd broad branch associates

Thank you!

wwww.mchip.net

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