Swaziland
Using Incentives to Improve Performance and Retention of Health Care Workers in Public Health Clinics in Swaziland
Many low-resource countries are implementing strategies to retain health care workers (HCWs) and to improve performance. Pay for performance is a strategy used to achieve health results by providing incentives (monetary and non-monetary) to reward achievement of a predetermined performance target. Another strategy is to implement an incentive scheme focused on retention of HCWs. Incentive schemes to improve retention have shown mixed results, particularly over the long term. However, incentives to improve performance have a long history of effectiveness. Data from developed-country settings suggest that properly-applied performance-based incentives will also lead to improved retention as well as improved performance.
Health Systems 20/20 is implementing a pilot 12-month operational research activity to assess the effect of a performance-based incentive scheme to increase the delivery of HIV testing and counseling services and on retention of HCWs in Swaziland. Health Systems 20/20 is working closely with the Ministry of Health and PEPFAR partners to ensure this activity complements and leverages their activities. The performance incentives focus on reaching specific HIV/AIDS priority service targets for counseling and testing. The expected results include improvement in selected service delivery indicators and improved retention of HCWs in the study area.
Key questions being addressed by the pilot include:
- Does the applied package of incentives improve performance to reach defined targets for HIV/AIDS and other services?
- Is the cost of the incentive scheme worth the benefit achieved in improved performance?
- Does the use of performance incentives also improve health worker satisfaction and/or retention?
- What are the sustainable financing strategies for the incentive packages?
