Pay-for-Performance (P4P) to Increase Use of Maternal, Neonatal, and Child Health Services in Bangladesh

Financial incentives based on provider performance can improve maternal, neonatal, and child health care in Bangladesh.

The Issue

In Bangladesh, far too many pregnant women die during pregnancy or while giving birth. And far too many children die before the age of 5. The risk of both maternal and neonatal mortality is reduced when women use skilled prenatal, delivery, and postnatal care. However, suboptimal performance by service providers has been a key barrier to improving the availability and quality of maternal, newborn, and child health (MNCH) services.

The Progress

Through a series of operations research studies, the Population Council developed and scaled up a team-based pay-for-performance (P4P) program that is significantly improving the quantity and quality of maternal and newborn health services provided at public-sector facilities in underserved areas of Bangladesh. Under the P4P model, a facility is provided with quarterly targets for the number of women served and the quality of care provided to each patient. Initial targets are based on the facility’s prior one-year average; in subsequent quarters, once targets have been met they are increased based on mutual agreement with the facility staff.

For each quarter that targets are met, every member of the facility’s MNCH team receives an additional one-month’s basic salary as an incentive. If targets are exceeded, staff receive a bonus equivalent to 1.5 months of basic salary. These financial incentives are intended both to improve the services women receive and to motivate providers to remain in remote or rural areas rather than moving to urban areas.

The Council completed an initial study on the feasibility of introducing a P4P financing mechanism, funded by the Center for Global Development, followed by an operations research study funded by UNICEF to develop and test the model. The Council recently completed this 30-month study at 12 health care facilities, serving more than 69,000 women.

The Impact

The P4P model successfully improved the quality of maternal health services offered in health care facilities, and in turn encouraged more women to use these services. At the 12 health care facilities participating in the study, the volume of skilled antenatal services pregnant women received almost tripled, delivery services doubled, and postnatal services quadrupled.

The Population Council is working with the Government of Bangladesh to introduce the model into additional regions, particularly focusing on underserved rural areas.

Principal Investigator

  • Ubaidur Rob Senior Associate & Bangladesh Country Director, Bangladesh

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