April Williamson | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Senegal’s Performance-Based Incentives (PBI) program (known as FBR) rewards health care providers financially for the quantity and quality of specified health services provided. We undertook a study to examine: (1) to what extent and (2) how providers in the FBR program react to the quality incentives (the “black box” of reactions to PBI).

Methods: We examine performance data, administer structured interviews of individual providers, and conduct focus group discussions to better understand provider behavior change under FBR. The study is performed in geographical areas where the FBR program has been in place since 2012 (intervention areas) and where FBR has not been implemented (control areas). Although the sample sizes are small and the assignment of FBR to specific geographical areas has not been random, the comparison provides insights into the effects of FBR on provider behavior concerning quality when subject to incentives.

Results: We will present the results of this investigation against our hypotheses that providers subject to FBR will make a) greater use of available tools and approaches to improve quality; b) be creative and entrepreneurial; c) be more responsive to the needs and wants of the patients; d) use RBF results-based payments at their disposal to improve quality in their facility, seek additional tools, advice, and financial and in-kind resources; e) be more conscious of quality in their work; and f) be limited by their knowledge of what to do and by the supplies and equipment available to them.

Conclusions: The results of the study are expected to influence modification of the instruments used to evaluate quality within the FBR program and to suggest complements that might make easier the attainment of better quality. In addition, this study contributes to the growing body of literature on the effect of PBI on provider behavior.