Performance-based incentive matters to increase utilization of maternal, newborn and child health services in Bangladesh
Presentation at the American Public Health Association 139th Annual Meeting and Exposition, 31 October
Rob,Ubaidur; Rahman,Laila; Talukder,Md.Noorunnabi; Hena,Ismat Ara
Publication date: 2011
In Bangladesh, despite having a comprehensive maternal, newborn, and child health (MNCH) service-delivery infrastructure from grassroots to higher levels, there is significant underutilization of the existing capacity. Shortages and suboptimal performance of service providers are key barriers to improving the availability and quality of MNCH care services. An operations research project is undertaken to test the feasibility of the pay-for-performance (P4P) approach, which offers financial incentives to reward service providers for meeting certain performance measures, as a way to address underutilization of services and quality of care. Under this study, the P4P approach is being tested in 12 government health facilities. The study is using a separate sample pre- and post-test control group design.The duration of the intervention is 12 months. Quarterly targets for MNCH services are set for the institution as a whole, which take into account both quantity and quality of services. Managers, direct and indirect service providers, and support staff related to MNCH services receive incentives upon achieving the institutional targets. Incentives vary across providers according to their level of effort. Field workers receive incentives for successfully referring complicated cases to the study facilities. Currently, the intervention is in the second quarter. Assessment of the performance in the first quarter indicates that 11 out of 12 study facilities have achieved targets by improving both the quantity and quality of services. This indicates that incentives have the potential to entice service providers to perform to reach the target within the stipulated time.