Pay for Performance

There is increasing evidence that providing incentives to service providers by linking payment to verified performance can lead to impressive improvements in critical areas like immunization coverage, utilization of prenatal care, and deliveries attended by skilled birth attendants. Subsidizing transportation costs and providing payments to overcome other household obstacles to accessing care has also shown considerable promise. This approach, called Pay for Performance (P4P), was the subject of three previous Africa regional workshops held in Rwanda, and recently, the first Asia regional workshop, held in Cebu, Philippines, from January 19-23, 2009.

Asia Pay for Performance Workshop

USAID’s Health Systems 20/20 Project, in collaboration with AusAID, the Center for Global Development, Norad, and the World Bank, delivered the first Asia Regional Workshop on Pay for Performance (P4P), January 19-23, 2009, in Cebu, Philippines. The workshop attracted more than 80 participants, including donor representatives, expert presenters from around the world, and 14 sponsored country teams from nine Asian countries: Afghanistan, Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, the Philippines, and Vietnam.

Through the workshop, participants learned about P4P approaches that have achieved remarkable results in countries as diverse as India, Afghanistan, Bangladesh, Haiti, Nicaragua, Pakistan, Rwanda, and the U.S., how to work together as a team to identify what is impeding good performance, and how to design and implement a performance-based financing approach to health customized for their countries. A field visit to settings in Cebu that have implemented an innovative P4P approach to ensuring that children with severe pneumonia and diarrhea are treated appropriately, called "QIDS," concretely demonstrated the approach to participants.

Over the course of the workshop, all 14 teams completed draft designs (called “Blueprints”) to introduce or scale up a pay-for-performance scheme in their country to improve maternal and child health outcomes. With the completion of their Blueprints, all the participating teams are now eligible to apply for a seed grant from AusAID (for $80,000) or from the World Bank (for $50,000) to continue the process of design, planning, and stakeholder consultation. Seed grants enable country teams to brief key policy makers, consult with stakeholders to obtain feedback on design and to generate buy-in, assess operational capacity and constraints, and develop a full plan to implement P4P in their countries.

Prior to the workshop, Health Systems 20/20 provided a two-day training for nine consultants who work in the Asia region. The consultants assisted the country teams during the workshop, documented their observations of the teams’ issues and questions, and will be available in the future for technical assistance.