Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized.

Overview

Introduction

Performance-based financing for health services has become popular with international donors as an effort to achieve the Millennium Development Goals (MDGs). Pilot projects using a pay-for-performance (P4P) approach, where health workers are paid based on the volume and/or quality of services provided, have rapidly expanded around the world, especially in low- and middle-income countries, yet without a similar growth in the empirical evidence base.

Afghanistan started its own P4P programme with support from the World Bank (WB) in 2010 as a means of increasing coverage and quality of priority maternal and child health (MCH) services, covering about one-third of the country.

This paper reports on the main outcomes of a large-scale cluster-randomized trial of P4P that ran between September 2010 and December 2012.