Performance-Based Incentives for Maternal Newborn Health: What Is the Role of Quality?

By: The Maternal Health Task Force and USAID’s Translating Research into Action (TRAction) Project

Increasingly, low- and middle-income countries, with support from their development partners, are investing in Performance-Based Incentives (PBI) schemes to improve health facility performance, including quality of care.  With the adoption of the Sustainable Development Goals (SDGs), increasing utilization of facility-based care remains a key strategy for improving maternal and newborn health outcomes and preventing death and disability. PBI is one approach being used to improve the availability and quality of facility-based care, which is in turn expected to increase service uptake. PBI also features prominently in the recently launched Global Financing Facility, which will serve as an important financing platform in support of the SDGs and the UN Global Strategy for Women’s, Children’s and Adolescents’ Health.

As PBI programs and other strategies to increase utilization of facility-based care move forward, there is an ethical imperative to understand the quality of care being accessed by women and children in these facilities, and a programmatic imperative to understand the returns to maternal and newborn health of PBI investments in terms of both quantity and quality of care.

In most PBI programs, measurement of facility performance involves assessing both the quantity and quality of services rendered in order to award incentives. Whereas assessing quantity of services is fairly straightforward, defining and measuring quality is a more complex endeavor.  Understanding the structural, process, and outcomes indicators directly linked to quality of maternal and newborn care is key.

The Maternal Health Task Force is excited to host a technical consultation with USAID’s Translating Research into Action (TRAction) Project together with USAID and the World Bank.  On Wednesday and Thursday of this week, researchers, programmers, policymakers, and donors from all over the world will gather in Boston to discuss the state of the evidence of performance-based incentives’ impact on the quality of maternal newborn care.

We are convening this meeting for two reasons: first, to better understand what the intended and unintended consequences are of PBI programs and the resulting quality of care offered to women and newborns; and secondly, to make recommendations for applying this knowledge systematically to improve care.  We will look at evidence gaps and implementation science priorities, policy/governance and program needs, and measurement issues.

Please stay tuned for updates throughout the meeting via social media using the hashtag #PBIMNH as well as a summary blog post next week reporting out on the discussion.