Last week, the Center for Global Development (CGD) hosted a launch for a new book called Performance Incentives for Global Health: Potential and Pitfalls. In the book, authors Rena Eichler and Ruth Levine, as well as members of CGD’s Working Group on Performance-based Incentives, describe a way to finance development which is receiving increasing attention – the transfer of money or services to patients or providers in exchange for taking action to improve health or meeting performance targets. The book examines the successes of these programs in Haiti and Rwanda, as well as Nicaragua and other examples from around the world.

In Haiti, institutional deliveries by skilled attendants increased by over 19% at NGOs which received payments based on results achieved in comparison to those paid based on inputs (like health workers trained, for example).

In Rwanda, provinces with performance-based financing reported the largest increases in the quantities of both curative and preventative care services. These provinces also outperformed non-performance-based ones in terms of effective management of deliveries and referral systems. As a result of encouraging results from these pilots, the Ministry of Health scaled up to a national model of performance-based financing.

In Nicaragua, immunization coverage increased more than 30% in areas which implemented a cash transfer program similar to the one described in our blog post from last Tuesday, in comparison to areas that did not implement this type of program. Amongst the poorest, the increases in immunization rates were even greater than 30%.

Other countries in Latin America, such as Colombia and Mexico, reduced child stunting by 6.9% and 29% in girls through cash transfer programs. In Russia, providing food, travel subsidies, and other services for patients with tuberculosis helped to reduce treatment default rates from 15-20% to 2-6%, which means more people continued to receive the treatment they needed.

Performance-based incentives are not a cure-all for all health system problems, but they are a promising tool for increasing service usage and performance. As authors Eichler and Levine noted, this strategy may be particularly useful where current incentive structures fail to reward strong performance, where households face financial, physical and social barriers to access, and in weak-state settings.

-Rena Pacheco-Theard & Lisa Fleisher