Monday, February 27, 2012

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

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

Sophie Witter1, Atle Fretheim2,5, Flora L Kessy3, Anne Karin Lindahl4

1Immpact, University of Aberdeen, Aberdeen, UK. 2Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 3Ifakara Health Institute (IHI), Dar es Salaam, Tanzania. 4Norwegian Knowledge Centre for the Health Services, Oslo, Norway. 5Institute of Health and Society, University of Oslo, Oslo, Norway

Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD007899

Available online PDF [83p.] at:

“…..There is a growing interest in paying for performance as a means to align the incentives of health workers and health providers with public health goals. However, there is currently a lack of rigorous evidence on the effectiveness of these strategies in improving health care and health, particularly in low- and middle-income countries. Moreover, paying for performance is a complex intervention with uncertain benefits and potential harms.
A review of evidence on effectiveness is therefore timely, especially as this is an area of growing interest for funders and governments.


To assess the current evidence for the effects of paying for performance on the provision of health care and health outcomes in low and middle-income countries.

Search methods

We searched more than 15 databases in 2009, including the Cochrane Effective Practice and Organisation of Care Group Specialised Register (searched 3March 2009), CENTRAL (2009, Issue 1) (searched 3March 2009),MEDLINE, Ovid (1948 to present) (searched 24 June 2011), EMBASE, Ovid (1980 to 2009Week 09) (searched 2March 2009), EconLit, Ovid (1969 to February 2009) (searched 5 March 2009), as well as the Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 8 September 2010). We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature and contacted experts in the field. We carried out an updated search on the Results-Based Financing website in April 2011, and re-ran the MEDLINE search in June 2011.

Selection criteria

Pay for performance refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: changes in targeted measures of provider performance, such as the delivery or utilisation of healthcare services, or patient outcomes, unintended effects and/or changes in resource use. Studies also needed to use one of the following study designs: randomised trial, non-randomised trial ….”


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