Center for Global Development presented a lunch seminar on Contracting for Primary Health Care in Uganda: An Experiment in Performance-Based Payment featuring Mattias Lundberg, Senior Economist, Human Development Network, World Bank. Rena Eichler, President, Broad Branch Associates, served as the discussant and Ruth Levine, Vice President of Programs and Operations, Center for Global Development, moderated the discussion.
Lundberg's presentation (pdf, 352K) reviewed the outcomes to date of an experiment that addresses this question in five districts in Uganda. The primary goal of this study is to understand whether the introduction of a performance-based contract between the purchaser (the government) and private not-for-profit (PNFP) providers of health services affected both the production and targeting of health services. The Ugandan government, like most low-income country governments, has public health goals, but a limited budget. It supports PNFP facilities to provide basic care, but the task remains to encourage the PNFP health care providers to deliver the correct mix of services to the appropriate target audience.
The evidence from the study supports two conclusions. First, assignment to the performance-based bonus scheme has not had a systematic or discernible impact on the production of health care services provided by PNFP facilities. Second, it appears that facility autonomy in financial decision-making has a positive impact on health care production. Part of the discussion will focus on why these results may be different from other experiences of performance-based incentive schemes in poor countries.