Output-based Contracting for Health Services in Uganda

Featured Speakers: Mattias Lundberg, World Bank and Rena Eichler, Broad Branch Associates

What is the best way to spend public resources to achieve the most effective health coverage in Uganda? To find out, the World Bank conducted an experimental study on performance-based incentives in the Ugandan health care system. This study analyzed the Private-Not-For-Profit (PNFP) sector, which represents a third of all facilities as well as half of all health care in the country. PNFP programs have focused on decentralization (i.e. budget transfers to districts) and the elimination of public sector fees, making their services much more efficient than those of the Ministry of Health.

The Center for Global Development held a roundtable to discuss the study’s findings. The goal was to assess whether providing performance bonuses to health care centers which achieved previously established targets increased the quality of their services. The final exit poll results, however, showed that centers selected for survey did not improve services to their clients, based on a number of indicators such as overall cost and waiting time. This conclusion may seem to suggest that performance-based incentives do not work in Uganda, but this assessment may be too hasty. It is possible that the monetary bonuses may not have been large enough to make a difference or that the reforms implemented by the health centers may not have been given enough time to take hold.

The conclusion of the study was therefore that more money is not the solution to increasing the quality of health care in the PNFP sector. The roundtable also highlighted that with research comes responsibility. This is particularly true in the health sector where recommendations have the potential of influencing policy change. It is therefore incumbent on researchers to ensure their findings are accurate before presenting final results to the government, thus preventing premature action such as funding cuts to the PNFP sector in Uganda.

Sponsor: Center for Global Development
Location: 1776 Massachusetts, NW
Date: June 6, 2007
Time: 12:30-2:00pm
Approximate Number of Attendees: 25
Intern Attending: Alexandra Martins