title: An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  In high-resource settings, 'pay-for-performance' (P4P) programs have generated interest as a potential mechanism to improve health service delivery and accountability. However, there has been little or no experimental evidence to guide the development or assess the effectiveness of P4P incentive programs in developing countries. In the developing world, P4P programs are likely to rely, at least initially, on external funding from donors. Under these circumstances, the sustainability of such programs is in doubt and needs assessment.
  
  
  METHODS
  We describe a cluster-randomized controlled trial underway in 18 health centers in western Kenya that is testing an innovative incentive strategy to improve management of an epidemiologically and economically important problem--diagnosis and treatment of malaria. The incentive scheme in this trial promotes adherence to Ministry of Health guidelines for laboratory confirmation of malaria before treatment, a priority area for the Ministry of Health. There are three important innovations that are unique to this study among those from other resource-constrained settings: the behavior being incentivized is quality of care rather than volume of service delivery; the incentives are applied at the facility-level rather than the individual level, thus benefiting facility infrastructure and performance overall; and the incentives are designed to be budget-neutral if effective.
  
  
  CONCLUSIONS
  Linking appropriate case management for malaria to financial incentives has the potential to improve patient care and reduce wastage of expensive antimalarials. In our study facilities, on average only 25% of reported malaria cases were confirmed by laboratory diagnosis prior to the intervention, and the total treatment courses of antimalarials dispensed did not correspond to the number of cases reported. This study will demonstrate whether facility rather than individual incentives are compelling enough to improve case management, and whether these incentives lead to offsetting cost-savings as a result of reduced drug consumption.
  
  
  BACKGROUND
  ClinicalTrials.gov Registration Number NCT01809873.
authors: Department of Epidemiology and Nutrition, Moi University School of Public Health, College of Health Sciences, Nandi Road, Eldoret, Kenya.
authors: Diana
authors: D
authors: Menya
authors: John
authors: J
authors: Logedi
authors: Imran
authors: I
authors: Manji
authors: Janice
authors: J
authors: Armstrong
authors: Brian
authors: B
authors: Neelon
authors: Wendy Prudhomme
authors: WP
authors: O'Meara
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000191:economics / Q000592:standards; D001432:Bacteriology / Q000191:economics / Q000193:education; D019090:Case Management / Q000191:economics; D002985:Clinical Protocols; D016000:Cluster Analysis; D005334:Fever / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D009042:Motivation; D012052:Reimbursement, Incentive; D019035:Rural Health Services / Q000191:economics*; D018401:Sample Size
chemical_list: D000962:Antimalarials
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