A pay-for-performance innovation integrating the quantity and quality of care in maternal, newborn and child health services in Bangladesh

The Population Council explored the possibilities of introducing a Pay-for-Performance (P4P) scheme in Bangladesh to improve maternal, newborn and child healthcare (MNCH) services. Based on the consultation and with guidance from the Government of Bangladesh, the Population Council and UNICEF provided technical assistance to the Directorate General of Health Services (DGHS) to test two P4P strategies for MNCH service providers to improve service volume and quality of care, and for poor clients to receive services subsidized through vouchers or coupons. The first strategy is a combination of pay-for-performance for providers and subsidized coupons for poor pregnant women, newborns, and under-five children, while the second strategy employs only the pay-for-performance incentives for the providers. Both strategies performed well relative to the comparison site, however strategy II with incentives for providers alone can be introduced at the low-performing but poorer regions; while the poorest areas with greater geographical draw back will benefit from a combination of a demand plus supply side P4P approach. The report acknowledges that monetary incentives alone are NOT enough to improve the MNCH services and that long-term solutions require putting a stronger system in place