From the article:
BOUCAN CARRE, Haiti — The people who live in this part of Haiti’s Central Plateau need more of pretty much everything that makes life safe, comfortable and predictable.
Three-quarters of families do not have enough food and two-thirds do not have access to clean water. Thirty percent of households are headed by women, and 40 percent of children are not in school. One in four children is unvaccinated, and half are underweight. About 80 percent of houses do not have latrines, and 60 percent of farmers do not own the land they cultivate, according to a survey of 5,200 families in the commune, or county, of Boucan Carre.
Is it realistic for people to make headway against so many problems on their own? Several centuries of poverty would suggest the answer is no. Would a personal assistant help? An experiment here may answer that. Half of the commune’s 10,000 households are being assigned a “household development agent” — a neighbor who will work as a health educator, vaccinator, epidemiologist, financial analyst, social worker, scheduler and advocate all at the same time. With the agent’s help, a family will assess its needs and come up with a plan to make things better.
The all-encompassing nature of the job is not the only unusual feature of the project, which is called Kore Fanmi — “family support” in Creole. The agents will also be eligible for pay-for-performance (“P4P”) bonuses. “If their families perform better, they will receive more salary,” said Francesca Lamanna, a World Bank economist. “This will help them do their jobs better.”
“P4P” is rapidly becoming a feature of American medicine, including with Medicare. But it is “kind of a new fad in global health,” said Amanda Glassman, an economist at the Center for Global Development in Washington. Evidence suggests it improves outcomes, at least for a while. Critics worry it may lead to people gaming the system and undermine professionalism.
“These World Bank experiments are going to be very useful to generate knowledge, not just for Haiti but for other countries that are interested in doing this,” Glassman said.