A pay-for-performance innovation for improving maternal health services in Bangladesh

In Bangladesh, low use of facilities for maternal health services in rural areas has been a critical challenge to the health system in reducing maternal mortality. Health facilities in rural areas operate at less than their capacity due to shortage and sub-optimal performance of service providers. An operations research was conducted to test the feasibility of pay-for-performance (P4P) approach, through which financial incentive was provided to motivate the team of managers, direct and indirect providers, and administrative and support staff of a facility for achieving both quantity and quality targets on maternal health services set for the institution on quarterly basis. Performance of a facility was measured using service statistics and quality assessment reports. An external body with an obstetrician, an anesthesiologist and a pediatrician was formed to assess the facility performance every three months and subsequently incentive was paid to the eligible facility. Performance-based incentive motivated additional efforts which caused to increase service volume remarkably, and the facilities also succeeded in improving quality of services. Performance-based incentive is required until it significantly increases the rate of institutional delivery, a key requirement to reduce maternal mortality.