What types of incentive does evidence show have proved successful in raising the quality of services, at the levels of the district, the health facility, and of individual health workers? How have specific incentives modified outputs and outcomes? This report builds on the HDRC helpdesk report on accreditation for health facility standards.
This report includes the following sections:
Financial incentives that have proved successful in raising health service quality include Pay-for-Performance in Rwanda which has increased the contraceptive prevalence rate, the percentage of births attended, reduced child mortality and increased vaccinations. Performance-based incentives improved indicators in Argentina including a 10-40% increase in the percentage of women receiving the required number of antenatal care visits. Also, monetary payments based on implementation of quality improvement plans in Honduras has significantly improved quality of care indicators.
Non-financial incentives for healthcare workers include rotating midwives between rural and urban facilities which has helped services to reach remote areas in Malawi. Additionally, one study shows that health workers are strongly guided by their professional conscience and similar aspects related to professional ethos.
Successful accreditation schemes include PROQUALI in Brazil, The Yellow Star programme in Uganda and The Gold Star scheme in Egypt.
Bolton, L. Helpdesk Report: Incentives for Improving the Quality of Health Facilities. Human Development Resource Centre, UK (2011) 6 pp.