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Performance-based Incentives

Challenge

Performance-based incentives (PBI) or pay-for-performance (P4P) is a strategy that links payment to results. Incentives can be given to patients when they take health-related actions; to healthcare providers when they achieve performance targets; or to health managers at the district, provincial and national level. PBI programs are designed to encourage behaviors that both increase demand for and use of health services, and improve the quality and availability of those services. Where PBI is being tried, the evidence suggests it can help to strengthen health systems, and achieve progress towards the Millennium Development Goals.

Approach

 Health sector stakeholders increasingly view PBI/P4P as an important complement to investing in inputs such as buildings, drugs, and training. In countries where P4P is being tried, the evidence suggests it can help to strengthen health systems, achieve progress towards the Millennium Development Goals, and improve health outcomes.

Health Systems 20/20 is engaged in PBI efforts globally, having led and developed workshops in Asia and Africa and developed a P4P Blueprint Guide, which takes countries through the PBI design process. Other recent activities include technical assistance to countries designing and evaluating PBI schemes (Afghanistan, DRC, Mozambique, Senegal); the development of a case study series; and review of PBI experiences to improve maternal and child health. Health System 20/20 also has a collection of tools, ranging from sample contracts, to verification manuals and training materials.

This collection of P4P tools illustrates the complexities of scheme design and implementation and can help to inform countries interested in introducing PBI/P4P.

Health Systems 20/20 and Pay for Performance (P4P) brief

Useful Links

• Explore the World Bank's results-based financing website
• See a recent Center for Global Development book: Performance Incentives for Global Health: Potential and Pitfalls

We invite you to sign up for the Performance Based Incentives Network (PBIN), a place where a wide range of participants from implementers from around the globe, academics and donors post papers, news, and share information on PBI/P4P. We also welcome learning more about PBI/P4P efforts that are underway where you work. Send us your stories.