Pay-for-performance and the Millennium Development Goals

Abstract

Only 23 countries are on course to reach Millennium Development Goal (MDG) 5: to reduce maternal mortality ratio by 75% by 2015. 1 Hogan MC Foreman KJ Naghavi M et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010; 375: 1609-1623 Summary Full Text Full Text PDF PubMed Scopus (1413) Google Scholar One reason for this slow progress is that, in many low-income and middle-income countries, most poor women deliver at home without skilled attendance, and thus face a high rate of obstetric complications. Our recent analysis, for example, found that in sub-Saharan Africa, from 2003 to the present, 78% of births among the poorest women occurred at home, of which 56% were unattended. 2 Montagu D Yamey G Visconti A Harding A Yoong J Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One. 2011; 6: e17155 Crossref PubMed Scopus (190) Google Scholar Reasons for this high rate of unattended home births include poor availability of health facilities, and social and cultural preferences for home delivery. 2 Montagu D Yamey G Visconti A Harding A Yoong J Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One. 2011; 6: e17155 Crossref PubMed Scopus (190) Google Scholar , 3 Koblinsky M Matthews Z Hussein J et al. on behalf of The Lancet Maternal Survival Series steering groupGoing to scale with professional skilled care. Lancet. 2006; 368: 1377-1386 Summary Full Text Full Text PDF PubMed Scopus (344) Google Scholar Increasing the proportion of poor women receiving skilled obstetric care is a complex public health challenge that defies easy solutions. Innovative approaches are desperately needed. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluationThe P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Full-Text PDF