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Improving Health Outcomes Through Performance Based Financing USAID Mini-University Johannesburg, South Africa April 3, 2008. John Pollock with inputs from Uder Antoine, Paul Auxila, David Collins, Bernateau Desmangles,
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with inputs from Uder Antoine, Paul Auxila, David Collins, Bernateau Desmangles,
Rena, Eichler, Gyuri Fritsche, Jean Kagubare, and Kathy Kantengwa, Louis Rusa
Working Definition: Transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target*
P4P imposes financial risk: Payment is received when (or withheld until) results (or actions) are verified
*source: Center for Global Development Working Group on Payment for Performance
NOTE: a summary of USAID-supported PBF initiatives is being prepared by Chris Barratt.
and has potential to accelerate the achievement of
Millennium Development Goals.
In Haiti in 2004 and 2005, immunization rates were held at levels over 90% during major social upheaval and though natural disasters
(public sector work uses memoranda of understanding)
When using Family Planning Indicators,
Tiahrt standards must be met
(CGD Working Paper 121) “Performance-based Incentives for Health: Six Years of Results from Supply-Side Programs in Haiti” (Rena Eichler, Paul Auxila, Uder Antoine, Bernateau Desmangles)
USAID projects: Fixed-price contract with performance fee
Has worked in both public sector (Rwanda) and
private sector (Haiti) -
Managers must have room to make decisions and to innovate
(the “Black Box”)
For Demand Side: Can connect target (immunized child) with
Established incentive (food supplementation/distribution)
in 4 health centers in the Gicumbi District in 2005/6.
saving $8.83 per VCT test (66%)!
Family Planning, Modern Methods, Users at the end of the Month Average per Health Center per Month
Results: FP Injections and oral methods at Health Centers % Increase in Prevalence over 24 months; (average absolute increase from 3.89% to 10.63%)
January 2006 through December 2007
Institutional Deliveries at the Health Center Average per Health Center per Month
Absolute coverage, December 2007
we already have ownership of the PBF initiative.
(avenues for reflection include mutuelles)
and is a good area for partner collaboration.
(excerpted from comments of Dr Louis Rusa, Director CAAC/MOH Rwanda 2/25/08)
(in relation to the full package of services)
(for Family Planning, Tiahrt standards must be met)
Consult with 2007 Kigali PBF workshop participants to discuss status and follow-up in other countries analyze five priority health problems that can be addressed through PBF