Perspectives on Performance-Based Incentive Programs to Improve Quality of Maternal Newborn and Child Health Care

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By: Sara Riese, Research Advisor, Translating Research into Action (TRAction)

A meeting which brought together implementers and experts in the fields of performance-based incentives, maternal newborn and child health (MNCH), and quality of care (QoC) was bound to get complicated.  Each of these fields has its own theories of change, indicators, measurement needs & approaches, and languages which they use to communicate amongst themselves.  But as performance-based incentive (PBI) programs increasingly move towards integrating and incentivizing quality of MNCH care performance measures within their programs, the need for collaboration and communication has never been more important. In order to start this conversation, USAID, the TRAction project, and the World Bank co-hosted the launch of a working group which will hopefully drive this collaboration.

Meeting participants reflected on a few key questions over the day and a half:

Since PBI programs are being implemented in countries across the globe, in both high and low resource settings-it is here to stay, in some form or another. How can PBI programs be made as effective as possible to improve quality of maternal and child health care?  What are the most important quality indicators to incentivize?

These questions brought out some of the clear differences between the different groups.  While the PBI implementers were seeking to develop a clear set of quality indicators that could be incorporated as measures into programs, presenters and members of the quality of care world talked of not using the word “quality” anymore since it is so vague, and members from the MNCH community spoke of how long it has taken (and continues to take) their own community to develop a core set of quality indicators.  In general most felt that a conceptual framework showing the potential areas of overlap and limitations of PBI and QoC is necessary before delving into a discussion on specific indicators.

How can this working group, or a group like it, advance the work on quality of care and PBI?

The group identified three key areas which emerged from the conversation: measurement strategies and indicators, gaps in knowledge and the “black box”, and navigating change.  Smaller groups delved into priorities within these particular areas and worked to create a short term work agenda in the area, identifying the key human and other resources needed, as well as whether there is scope for building a community of practice or email group around the area.

Results of those discussions can be found in the meeting report here.

Without a doubt, there are areas of overlap and synergy between the different fields.  Continued collaboration and discussion between these diverse groups is going to be necessary in order to identify the key areas of overlap and develop tools which will effectively respond to the needs of PBI implementers seeking to integrate measures of quality into their programs.

What do you see as areas of overlap between the performance-based incentive, quality of care, and maternal, newborn, and child health worlds? How can they work together to make a greater impact on the health of mothers and children around the world?