Improving quality of care through payment for performance
Essential drugs, supplies and equipment are key to delivering quality health services. In low and middle-income countries (LMICs), they are often unavailable in public facilities due to inadequate budget allocations or inefficient procurement and supply systems. When drugs and supplies are out of stock, patients must purchase them in private pharmacies and incur potentially substantial treatment costs.
Payment for Performance (P4P) has been identified as one potential strategy to improve access to life-saving drugs and supplies for reproductive, maternal, newborn and child health (RMNCH) by the recent United Nations Commission on Life-Saving Commodities. P4P is a purchasing mechanism that provides monetary incentives to health providers for achieving pre-defined performance targets. It is assumed that P4P can increase the availability of drugs and supplies by rewarding services that require their use, and by requiring that a share of incentive payments be invested in improving services, through for example, efforts to reduce stock- outs.
P4P schemes are currently being implemented in over 30 LMICs, with many countries scaling up nationally; however, there is sparse evidence about whether P4P improves the availability of drugs, supplies and equipment. RESYST research has examined the effect of P4P on the availability of drugs, supplies and equipment linked to the provision of RMNCH services in Tanzania, and assessed how these effects differed across facilities. The study was carried out as part of an evaluation of a P4P scheme in Pwani region, Tanzania.