Performance Incentives for Global Health: Potential and Pitfalls

Rena Eichler
the Performance-Based Incentives Working Group
May 28, 2009

Over the last decade, donors have poured billions of dollars into health programs in developing countries. But despite some important successes, many low-income countries are still falling short, particularly in areas that require a functioning health system. In Performance Incentives for Global Health: Potential and Pitfalls, Rena Eichler, Ruth Levine, and members of the Working Group on Performance-Based Incentives explore a new approach to health funding—the transfer of money or goods to patients or providers when they take health-related actions or achieve performance targets. Donors have traditionally paid for inputs—doctors’ salaries, medical equipment—in the hope that they would lead to better health. Performance incentives turn the equation on its head. They start with the result—more children immunized, for example—and let health workers and managers on the ground decide how to achieve them.

Performance Incentives for Global Health documents a host of experiences with incentives for maternal and child health care, tuberculosis, child nutrition, HIV/AIDS, chronic conditions and more. An accompanying short video (below) illustrates the use of performance incentives in Rwanda and Haiti and shares the perspectives of patients and health care workers. The evidence strongly suggests that incentives can improve health and strengthen health systems in a variety of settings.

As decision makers in developing countries and their donor partners look for practical ways to improve health-sector performance, real-world experiences show that they should look to performance incentives to complement increasing total spending on health.

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