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TRAction and Harvard’s Maternal Health Task Force convene a workshop on the role of quality in performance-based incentives programs

Wednesday, April 20, 2022

Cross-Posted from the Maternal Health Task Force Blog. Read more here.

The TRAction Project and Harvard’s Maternal Health Task Force, in collaboration with the World Bank and USAID, recently convened a two-day workshop examining the role of quality within performance-based incentives (PBI) programs with a focus on maternal and newborn services. The workshop, which brought together country representatives, policy makers, researchers, and funders, sought to gather the current state of evidence on how PBI programs affect quality of care in low and middle income countries. Participants shared their experiences with developing, implementing, and measuring PBI programs with explicit quality improvement objectives.

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.

This meeting was convened 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.

 

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