With rigorous economic research and practical policy solutions, we focus on the issues and institutions that are critical to global development. Explore our core themes and topics to learn more about our work.
In timely and incisive analysis, our experts parse the latest development news and devise practical solutions to new and emerging challenges. Our events convene the top thinkers and doers in global development.
A June 2009 CGD book, Performance Incentives for Global Health: Potential and Pitfalls, is the result of the analysis and deliberations of the Working Group on Performance-based Incentives, which was established to take stock of a growing set of international experiences with the use of “pay for performance” approaches.
The book and accompanying video have been widely shared with staff at leading institutions working in global health, including the GAVI Alliance, the Global Fund to Fight AIDS, TB and Malaria, the World Bank and several bilateral donors. In addition, the book has formed the basis for discussions within the International Health Partnership+’s InterAgency Working Group on Results-Based Financing.
Over the past decade or so, many countries -- often with the financial and technical support of donors -- have introduced performance-based incentives in the health sector. These are transfers of money or other material rewards that are provided contingent on improved performance or a particular type of behavior change. Some incentives have been designed to directly affect provider behavior, promoting delivery of more and better quality services; others have focused on stimulating changes in household or patient behavior, aiming to increase the use of health services and/or continuation of long-duration treatments for TB or other ailments. While only a few of the performance-based incentive programs have been subject to rigorous evaluation, significant experience has been accrued about how these approaches are working and how their introduction can reinforce (or compete with) other ways to strengthen health systems.
Working Group Objective
The central objective of the Working Group on Performance-Based Incentives was to learn from the application of performance incentives so that future global health programs can be more effective.
In February 2006, the Center for Global Development convened the Working Group on Performance-Based Incentives to review experiences with “paying for performance” in the health sector. The group used available evidence to take a look at how the innovations are working, how they are affecting (or could affect) the broader health system, and if and how they can be used to change key health-related behaviors. The resulting book, Performance Incentives for Global Health: Potential and Pitfalls, draws lessons for donor agencies and policymakers in developing countries seeking to broaden the menu of ways to improve health systems. The book synthesizes available evidence about how performance incentives affect utilization, quality and efficiency; provides guidance for the design, implementation and evaluation of performance incentive arrangements; and sets out recommendations for the donor community and for policymakers and program managers in developing countries. Case studies included in the book are:
Latin America: Cash Transfers to Support Better Household Decisions
United States : Orienting Pay-for-Performance to Patients
Afghanistan: Paying NGOs for Performance in a Postconflict Setting
Haiti: Going to Scale with a Performance Incentive Model
Rwanda: Performance-Based Financing in the Public Sector
Nicaragua: Combining Demand- and Supply-Side Incentives
Worldwide: Incentives for Tuberculosis Diagnosis and Treatment
Working Group Composition
Led by CGD vice president for programs and operations and senior fellow Ruth Levine, the Working Group consisted of individuals with expertise in institutional and household economics, health finance and management, quality of care and program implementation.