Online Program

Outcomes of a performance-based contracting strategy in south Sudan

Tuesday, November 5, 2013 : 3:15 p.m. - 3:30 p.m.

A. Frederick Hartman, MD MPH, Center for Health Services, Mangement Sciences for Health, Medford, MA
John Rumunu, MD, MPH, Shtp II, Management Sciences for Health, Cambridge, MA
Erin Polich, MPH, Shtp II, Management Sciences for Health, Cambridge, MA
Jemal Mohammed, Shtp II, Management Sciences for Health, Cambridge
Background: The USAID-funded Sudan Health Transformation Project II (SHTP II) developed performance-based contracts (PBCs) with 9 sub-contracting partners (SCPs) in 14 counties to support rapid expansion of the basic package of health services (BPHS). Methodology: Through SHTP II a performance matrix was developed that linked key indicators of BPHS achievements by the SCPs to payments using a select group of 11 project indicators covering both program and management activities. Scores < 80% paid only 95% of the scheduled payment (a 5% penalty); 80-100% resulted in full payment; and > 100% generated a 6% performance bonus. Results: After implementing this payment formula, SHTP II demonstrated a rapid and significant increase in the provision of the key BPHS, eg, coverage of DPT 3 increased from 30% to 86% in just two years. ANC 1 visits increased 287% and ANC 4 716% and IPT 2 increased from 29% to 53% of PW during this time period. Conclusion: In the first Q of implementation, only 2 counties received a performance bonus compared with 7 (50%) in the last quarter. Tying payment to indicator performance improved access to BPHS services by incentivizing program acheivements and rewarding good performance. PBCs can play a strong role in rapid expansion of access to services even in a fragile, post-conflict state like South Sudan.

Learning Areas:

Administration, management, leadership
Provision of health care to the public

Learning Objectives:
Identify the elements of a successful performance-based contracting strategy in community-based primary health care. State the positive outcomes of the use of this technial approach in improving access to basic health services.

Keyword(s): Contracting, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I supervised the SHTP II which used performance-based contracting to rapidly improve access to basic health services in South Sudan.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.