The health system effects of Pay for Performance in Pwani Region, Tanzania

Research story , 2016

In Tanzania close to 8,000 women and 40,000 newborns die every year during or shortly after childbirth from conditions that could have been prevented or treated with quality healthcare. Half of all births take place at home, without assistance from a skilled health worker and often in unhygienic conditions.

Pay for Performance (P4P) is one approach that has been piloted in Pwani region to increase rates of delivery in a health facility, as well as to improve maternal and child health more broadly. A recent evaluation of the intervention found that P4P increased rates of delivery by 8%. However, the effects of P4P go beyond service utilisation and quality.

In this video, researchers, policy makers and P4P co-ordinators discuss the effects of P4P on the wider health system, drawing on findings of a RESYST research project.

The research focused on the effects of P4P on three areas:

  • Financing: Facility resourcing and resource allocation process

  • Human resources: Health worker behaviour and relationships with patients

  • Governance: Relationships between workers and managers and accountability mechanisms

The research was conducted with the hope of shaping the nationwide rollout of P4P (also known as Results Based Financing) in order to maximise the positive impacts to the health system.

Related resources:

1. RESYST P4P research project overview

2. Effect of Paying for Performance on Utilisation, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study. Binyaruka P, Patouillard E, Powell-Jackson T, Greco G, Maestad O, Borghi J (2015)

3. Signs of P4P enhanced functioning of accountability in the health system: experience from Pwani Pay for Performance (P4P) pilot Presentation given at P4P workshop, Dar Es Salaam, Tanzania, Mayumana I (2015)

4. Maternal and child health overview UNICEF Tanzania,

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