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Results-Based Management

New mother waits with other parents to see a midwife for vaccinations and health education tips at a postnatal clinic in Tanzania. ©2012 FELM/organization, Courtesy of Photoshare

Results-Based Management

Results Based Management, including results-based financing, is increasingly applied in settings with various resource levels in efforts to achieve health care, patient outcome, and cost containment targets. To date most supply-side results based management strategies in low and middle income countries (LMICs) have focused on units of service delivery (e.g., number of antenatal visits) rather than quality of care measures (e.g., content of clinical care) given the historic low coverage of health care services in these settings. Increasingly, results based management and performance-based financing (PBF) programs in LMICs are seeking to include quality of care performance measures associated with improved health outcomes. An evidence review sponsored by USAID and the US Department of Health and Human Services (DHHS) in 2012 found a lack of conclusive evidence for impact of supply-side financial incentives on maternal health care measures and outcomes; in particular, evidence related to the effect of financial incentives on quality of maternal care was highlighted as an important gap in the published literature from low and middle income countries. Gaps also remain in testing innovative approaches to improve the availability and quality of care in low resource settings. These include non-financial incentives, human resources for health (HRH) distribution strategies, and sharing of HRH between public and private sectors etc. TRAction research in this area seeks to contribute to this evidence base.

Incentives for Quality

Photo of Tanzanian mother and child, Photoshare
Incentives for Quality

Performance Based Incentives (PBI) programs in developing countries have focused on expanding access and coverage of services and addressing issues of equity. Because PBI is a relatively new area of work that stresses increased utilization of services, there has been less attention paid to assessing and incentivizing quality of care or in understanding the unintended consequences of these programs on quality of other services. The goal of this TRAction-supported PBI research is to anticipate and help implementers address issues of quality of essential obstetric and newborn care in PBI programs. As new programs are developed or refined, quality will be essential to the sustainability of PBI programs.

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