Rewarding results: Performance based contracting in Liberia

The Performance Based Contracts (PBCs), managed by the Rebuilding Basic Health Services (RBHS) project, were to assist the Liberian Ministry of Health and Social Welfare (MOHSW) in the implementation of the National Health Plan by: i) improving the provision, quality and efficiency of services contained in the Basic Package of Health Services (BPHS) at facility and community levels; and ii) building the capacity of the government County Health Teams (CHTs). The five RBHS-supported PBCs and one grant (managed exactly the same as the contracts but without the system of penalties and bonuses) were implemented with local and international NGOs to provide services in seven counties and supported 112 facilities between July 2009 and June 2012. Funding was tied to the achievement of targets on 17 predetermined and agreed upon performance indicators; penalties of up to 5% of the quarterly payment were levied for not meeting administrative targets, and a bonus of up to 6% of the total contract amount was given for meeting or achieving service-delivery targets. To function efficiently and effectively, the PBC system relied heavily on rigorous, independent quarterly data validation and communication between the fund-holder (the RBHS project) and the contracted parties (the NGOs). Furthermore, rapid capacity building of implementing NGOs was required, as was the implementation of a number of ad hoc studies to ensure the validity and reliability of data upon which performance was measured. Successes and determinants will be reviewed, as will implications for scale-up of PBCs in Liberia and in similar contexts.