In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective.
Pay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs' costs or cost-effectiveness. We conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. We reviewed project accounts and reports, interviewed key stakeholders, and derived outcomes from a controlled before-and-after study. In 2012 US dollars, the financial cost of the pay-for-performance pilot was $1.2 million, and the economic cost was $2.3 million. The incremental cost per additional facility-based birth ranged from $540 to $907 in the pilot and from $94 to $261 for a national program. In a low-income setting, the costs of managing the program and generating and verifying performance data were substantial. Pay-for-performance programs can stimulate the generation and use of health information by health workers and managers for strategic planning purposes, but the time involved could divert attention from service delivery. Pay-for-performance programs may become more cost-effective when integrated into routine systems over time.
Josephine Borghi (jo.borghi@lshtm.ac.uk) is a senior lecturer in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine.
Josephine
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Borghi
Richard Little is a consultant health economist in Cambridge, England.
Richard
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Little
Peter Binyaruka is a research scientist at the Ifakara Health Institute.
Peter
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Binyaruka
Edith Patouillard is a senior scientific collaborator in the Epidemiology and Public Health Department, Health Intervention Unit, Swiss Tropical and Public Health Institute, in Basel; the University of Basel; and the World Health Organization Global Malaria Programme, in Geneva, Switzerland.
Edith
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Patouillard
August Kuwawenaruwa is a research scientist at the Ifakara Health Institute, in Dar es Salaam, Tanzania.
August
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Kuwawenaruwa
D003362:Cost-Benefit Analysis / Q000379:methods*; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D015276:Health Care Rationing / Q000191:economics* / Q000458:organization & administration; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D020380:Needs Assessment; D010865:Pilot Projects; D011203:Poverty; D012052:Reimbursement, Incentive / Q000191:economics* / Q000458:organization & administration; D018570:Risk Assessment; D013636:Tanzania
Cost of Health Care; Developing World < International/global health studies; Financing Health Care; Health Economics; Health Reform