Performance-based payment to improve the impact of health services: evidence from Haiti.

Abstract

Holding health institutions accountable for achieving explicitly defined results by linking reimbursement to results can be a powerful strategy to improve health system performance. In Haiti, USAID introduced performance-based payment as the mechanism to pay nongovernmental organizations after a population-based survey identified poor performance in NGO services. Examples of poor performance included immunization coverage of 7 % and contraceptive prevalence rates as low as 6%. Rather than the previous system that reimbursed NGOs for documented expenditures up to a ceiling, performance increase targets were established and a portion of the historically funded budget received by NGOs was withheld. NGOs had the opportunity to earn back the withheld amount plus a bonus if these performance targets were reached. This pilot study, which involved three NGOs for one year, showed marked improvements in immunization coverage and positive changes in organizational behavior.

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