Performance-based incentive matters to increase utilization of maternal, newborn and child health services in Bangladesh

In Bangladesh, despite having a comprehensive maternal, newborn and child health (MNCH) service delivery infrastructure from grassroots to higher levels, there is significant underutilization of the existing capacity. Shortage and sub-optimal performance of service providers are key barriers to improve availability and quality MNCH care services. An operations research project is undertaken to test the feasibility of pay-for-performance (P4P) approach, which offers financial incentive to reward service providers for meeting certain performance measures, as a way to address underutilization of services and quality of care. Under this study, P4P approach is being tested in 12 government health facilities. The study is using a separate sample pre- and post-test control group design.

The duration of the interventions is 12 months. Quarterly targets for MNCH services are set for the institution as a whole, which take into account both quantity and quality of services. Managers, direct and indirect service providers and support staff related to MNCH services receive incentive upon achieving the institutional targets. Incentives vary across providers according to their level of efforts. Field workers receive incentive for successfully referring complicated cases to the study facilities. Currently, the intervention is in the second quarter. Assessment of the performance in first quarter indicates that 11 out of 12 study facilities have achieved targets, by improving both the quantity and quality of services. This indicates that incentive has the potential to entice the service providers to perform to reach the target within the stipulated time.