Performance-based financing inlow-and middle-income countries

Abstract

The pay-for-performance (P4P) tool has been used in low and middle-income countries in order to improve the performance of health-care providers. It helps to improve the quality of care and efficiency but has a drawback that it has a focus on a single condition and do not reflect the complexity of caring for patients with multiple conditions. To assess the impact of P4P on utilization of health service and quality of care in low- and middle- income countries. Different documents, papers, reports and literature were searched to assess the impact P4P on utilization and quality of health services and used Google search engine for this purpose. Analysis of the papers and project documents from 2002 to 2012 was conducted. The P4P schemes range from very large national programs to localized pilots and has been successfully implemented in post-conflict/fragile areas. Pay for performance model implemented in Dera ghazi Kahn district in Pakistan through free of cost vouchers given to pregnant women for antenatal checkup and transport facilities. The facility based deliveries increased from 20 to 90%. In Morocco, P4P model implemented through paid to the physicians for quality of care, screening of cervical cancer increased from 1.7 to 5.3% and hemoglobin A1c increases from 0.2 to 2.1%. Pay for performance increase the utilization of health services and quality of health services but it is constrained by certain challenges such as immature non-governmental international organizations (NGO) service sector with weak managerial and technical capacity, conditional cash transfers to households in countries with a large proportion of the population considered poor.