PerformanceBased Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion? Working Paper No

Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes. Performance-based incentives in TB control programs include financial and material incentives directed to patients, individual health workers (in the public and private sectors), and entire health care facilities. Those directed toward patients encourage individuals to seek care (a diagnosis) and are conditional on completing steps in the treatment process to ensure adherence to the length