In Tanzania, The Many Costs Of Pay-For-Performance Leave Open To Debate Whether The Strategy Is Cost-Effective

In a pay-for-performance programme health care providers receive additional financial rewards and incentives for achieving certain service coverage or quality of care provision. A pilot study run by the Ministry of Health and Social Welfare has been ongoing since 2011 in Pwani region. This study estimated the cost-effectiveness of the pilot programme in one region, and estimated the cost-effectiveness of the programme if it were scaled up to cover all of Tanzania. There were substantial additional costs associated with the setting up of the programme, training, management and data verification. Pay-for-performance led to an additional 2746 facility deliveries during the period leading to an additional cost of $7304 across all households in Pwani. The average cost per women of reproductive age was $10, and the additional cost for each additional facility delivery was $907. Rolling out the study nationally over a 5 year period would incur  over $760,000 in financial costs and $2.2 million in economic costs (86% on training). For each additional facility delivery a cost of between $94 and $261 would be incurred. The pay-for-performance programme was motivating for staff, but was time-consuming to establish and required an additional burden of data collection. The cost of national roll-out would depend on how integrated the programme is into existing data collection and technical systems. To read the article, click here.  Payment of subscription is required to access the full article.Borghi, J., Little, R., Binyaruka, P., Patouillard, E., & Kuwawenaruwa, A. (2015). In Tanzania, The Many Costs Of Pay-For-Performance Leave Open To Debate Whether The Strategy Is Cost-Effective Health Affairs, 34(3), 406-414.