Cochrane Summaries

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Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Witter S, Fretheim A, Kessy FL, Lindahl AK
Published Online: 
31 May 2013

Researchers in the Cochrane Collaboration conducted a review of the effect of paying for performance to improve the delivery of health care in low- and middle-income countries. After searching for all relevant studies, they found nine studies that met their requirements. The findings of this review are summarised below.

What is pay for performance?

In a 'pay for performance' approach, people are given money or other rewards if they carry out a particular task or hit a particular target. This approach can be directed at patients, health workers or healthcare organisations. Patients are sometimes rewarded if they use particular healthcare services. Health workers and healthcare organisations may be rewarded if they offer particular services, if they deliver care that is of a certain quality, or if their patients make use of particular services. This review focused on pay for performance approaches that target the behaviour of health workers and healthcare organisations.

What happens when health workers and healthcare organisations are paid for performance?

The quality of the evidence was generally very low. The pay for performance approaches used in each study varied a great deal and the studies were carried out in a wide range of settings. It is therefore not possible to draw general conclusions. There is a need for more and better research in this area.