Alex Ergo, Ligia Paina, Lindsay Morgan and Rena Eichler

Performance-based incentive (PBI) schemes are rapidly gaining traction throughout developing world health systems. PBIs provide one option for intervening to improve the alignment between individual health systems actors’ underlying incentive structures and the broader system’s health goals. They complement health systems’ embedded financial and non-financial incentives.

Health care quality improvement has been at the core of PBI schemes in high-income countries (HICs). Given that many low- and middle-income countries (LMICs) struggle with low utilization of critical services, the primary objective of their PBI schemes has been to boost service use, linked to the achievement of the health-related Millennium Development Goals. Health care quality in developing countries has not yet received the same emphasis.

This paper provides guidance on developing stronger linkages between quality improvement and PBI in LMICs, by reflecting on current efforts in both HICs and LMICs and focusing mostly on supply-side schemes.

(Available on the MCHIP website)