POLICY ALTERNATIVES TO PERFORMANCE-BASED FINANCING
Figure 6.1 Typology and theory of change of included financial incentive interventions Financial incentive interventions Supply side PBF Provider income
Demand side Voucher
Provider income
CCT User fees
User income
RMCH service coverage
Source: Reproduced from Neelsen et al. 2021. Note: CCT = conditional cash transfer; PBF = performance-based financing; RMCH = reproductive, maternal, and child health.
financially reward enrollees for complying with maternal and child health (MCH) service use conditions. Performance pay, included in PBF programs, is thus essentially a supplyside intervention that increases health providers’ income when more and higher quality–targeted services are provided to patients, but it does not directly affect the user fees paid by households or their income. CCTs act on the demand side by increasing the household’s income when they use targeted services, but they do not directly increase providers’ incomes. Vouchers play a role on both the supply and demand sides: when a voucher is redeemed for specific services, the fee paid by patients is reduced and the income received by providers increases. A growing evaluative literature has explored the effectiveness of financial incentive interventions on health service coverage in low- and middleincome countries (LMICs), and an increasing number of reviews are available that synthesize this growing evidence base. For the emerging literature on PBF, the most recent comprehensive review (Diaconu et al. 2020), for
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