Transcript Presentation Title

Catalyzing Maternal and Child Health
Results by Paying for Performance:
Evidence from Developing Countries
Catherine Connor and Rena Eichler
Health Systems 20/20 Project
Abt Associates Inc.
In collaboration with:
 Aga Khan Foundation
 BearingPoint
 Bitrán y Asociados
 BRAC University
 Broad Branch Associates
 Forum One Communications
 RTI International
 Tulane University’s School of Public Health
 Training Resources Group
15 November 2010
Health Systems Research Symposium
What does pay for performance have to do
with reaching universal coverage?
Incentives to
use priority
services
Financing
options
Pop
Coverage
Incentives to cover
hard-to-reach
populations
Feasibility of Insurance Design
and Implementation
Benefits
package
Provider
engagement
Monitoring and Evaluation
Pay providers
for quality or
efficiency
Organizational
structure
Operations
Presentation Objectives
 What is Pay for Performance?
 Highlights from on-line survey of country experiences
 Expanding access for maternal and child health results:
the case of Burundi
What we mean by P4P
Payer
Donars. Govenment, NGOs
Health Programs, Insurers
Funds, Goods,
Other
Results
Recipient
Demand Side
Patients or Families
Service Providers (facility or health worker)
Supply Side
NGO or program implementer
Government - Local or National
What is P4P?
Many terms: results-based financing, performancebased financing, performance-based
contracting, conditional cash transfers, …
One common definition:
 “Transfer of money or material goods conditional
on taking a measurable health related action or
achieving a predetermined performance target” *
*From the Center for Global Development Working Group on Performance-Based Incentives
Pay-for-Performance (P4P)
An explosion of interest and funding
Why is P4P getting so much attention?
 Flat salaries for providers leads to low incentives to
provide quantity or quality or to serve the poor
 Fixing incentives is important complement to
infrastructure, technical, and capacity building
interventions
 P4P can be combined with any provider payment
method: Salary, FFS, capitation, case-based, global
budget
Snapshot of P4P Country Survey
 Why do this survey?
 To fill the gap between growing
experimentation and little
documentation
 Global online survey 2009
 90 e-responses
 25 responses summarized
 14 longer case studies in 2010
Distribution of 25 cases by region
Africa
Asia
Latin
Europe and
American and Eurasia
the Caribbean
Middle East
Benin
Burundi (2)
DRC(2)
Ethiopia
Ghana
Kenya (3, 1)
Rwanda
Tanzania
Uganda
Zambia
Bangladesh
Cambodia (2)
India
Philippines
Belize
Brazil
Honduras
Armenia
Egypt
15
5
3
1
1
Survey results: Purchasing focused on
priority services
 Maternal health results dominate (22/25).
 Child health results also top priority (14/25).
 Infectious (e.g. HIV/AIDS, malaria) and non-
communicable diseases (e.g. cancer
screening, diabetes and asthma
management) included but less frequent
Survey results: Designs to expand
access
 Primary care facilities
 Rural or peri-urban areas
 Community outreach
 Demand side (users/patients) - vouchers and
transportation subsidies
 Increasing attempts to reward quality
BURUNDI
Public-private
purchasing to
increase use of
priority
services and
improve quality
What drove interest in PBF in Burundi?
Facility use rate (consults/year/person) 1
0.47 (2004)
Births attended by qualified staff1
9.8% (2004)
DTP3 immunization1
54% (2004)
Measles immunization1
50% (2004)
Contraceptive prevalence rate2
9% (2005)
U5 sleeping under insecticide-treated net2
8% (2005)
1. Kaneza 2007; 2.http://healthsystems2020.healthsystemsdatabase.org/
P4P Purchasing – how it works
TechnicalAssistance
HealthNetTPO
Cordaid
Monthly payments
fee for service
+
quarterly bonus for
quality
MoF
Donors
$
Community
survey
Provincial
Purchasing
Agency
$
Quality
Assess
Health
Facilities
Facilities
report
utilization
each month
Burundi Results – Kibuye Province
Ap
ril
M
ay
Ju
ne
Ju
A u ly
Se gu
pt st
em
b
O er
ct
ob
No
er
ve
De mb
ce e r
m
be
r
1000
800
600
400
200
0
Ja
nu
Fe a ry
br
ua
ry
M
ar
ch
Figures
Number of womenFamily
using contraceptive
methods
Planning
doubles
months
Target
2006
2007
2008
Using P4P to expand access in developing
countries
 Many different designs
 Focus on maternal and child health
 Majority are supply-side (provider)
 Some are demand-side (user)
 Clear need for more documentation to learn what is
working and learn how design and implementation
challenges are being overcome
Thank you
Reports related to this presentation
are available at www.HS2020.org
Abt Associates Inc.
In collaboration with:
 Aga Khan Foundation
 BearingPoint
 Bitrán y Asociados
 BRAC University
 Broad Branch Associates
 Forum One Communications
 RTI International
 Tulane University’s School of Public Health
 Training Resources Group