Research for stronger health systems during and after crisis

Payment for Performance (P4P), how, why, where and what?

Learning from research across income settings: a one day workshop for researchers and practitioners

9th October 2018


ReBUILD contributions

  • Prof Sophie Witter will be the discussant in the first session on the role of incentive design in P4P

  • Dr Maria Bertone is taking part in the third session on how contexts moderate P4P

About the session

The provision of financial incentives to healthcare providers to improve service delivery, known as pay for performance (P4P),  is a global phenomenon that first emerged in the United States, Europe and other high income countries, and subsequently spread to low and middle income countries (LMIC).  P4P is the subject of growing international research.  However, the community researching P4P tends to divide into those concentrating on high income countries, and those working on LMIC. This limits the potential for learning across contexts which could strengthen our understanding of where P4P works and why, as well as enhance the research methods that we use to study P4P.  

This one-day event will bring together pay for performance researchers and policy makers working in high as well as low and middle income settings, to learn from each other.  Participants will examine research methods and results emerging from these different settings, and reflect on how they are shaped by the research and policy context to encourage dialogue between researchers and policy makers across income settings.


9-10.20am - Topic 1: The role of incentive design in P4P             

  • Chair: Martin Chalkley, University of York, UK

  • Rachel Foskett-Tharby, NHS England, UK: The evolution Quality of Outcome Framework: in England

  • Kunle Alonge, Johns Hopkins University, USA: Lessons learned from 15 years of performance-based financing for improving health services delivery in Afghanistan

  • Wiktoria Tafesse, University of York, UK: Application of industrial organization theory to inform Government contracting with faith-based providers in Malawi

  • Ivdity Chikovani, Curatio International Foundation, Georgia: Integrated care and Pay for Performance in TB outpatient care: an adapted intervention and innovative research in Georgia

  • Stefanie Tan, LSHTM, UK: Outcomes-based contracts to test preventative health interventions: the design and implementation of Social Impact Bonds to UK Health and Social Care

  • Discussant: Sophie Witter, Queen Margaret University, UK and the ReBUILD Consortium

10.50-11.45am - Topic 2: Spillover effects of P4P  

  • Chair: Stephen Peckham, University of Kent, UK

  • Philip Britteon, University of Manchester, UK: Spillover effects of pay-for-performance schemes: A systematic review of the literature

  • Jeffery C Tanner, World Bank: Spillover effects in Results Based Financing—Experience from a portfolio of impact evaluations

  • Discussant: Søren.R. Kristensen, Imperial College London, UK   

11.45am-12.50pm - Topic 3: How does context moderate P4P?    

  • Chair: Valéry Ridde, Universités Paris Sorbonne Cités, France

  • James Gaughan, University of York, UK: Pay for Efficiency: Incentivising same-day discharges in the English NHS

  • Peter Binyaruka, Ifakara Health Institute, Tanzania: Does payment for performance increase performance inequalities across health providers? A case study of Tanzania

  • Maria Bertone, Queen Margaret University, UK and the ReBUILD Consortium: Investigating results-based financing as a tool for strategic purchasing; comparing the cases of Democratic Republic of Congo, Uganda and Zimbabwe

  • Manassé Nimpagaritse, Institut National de Santé Publique, Burundi: Understanding the contextual factors surrounding the results of integrating new activities into an existing PBF scheme: the case of malnutrition in Health centers of Burundi

  • Discussant: Ruth McDonald, University of Manchester, UK

2- 3.10pm - Topic 4: Sustainability of P4P over time    

  • Chair: Fabiana Saddi, Federal University of Goiás, Brazil

  • Bruce Guthrie, University of Dundee, UK: The rise, fall and replacement of QOF in Scotland

  • Anna Wilding, University of Manchester, UK: Under pressure: family practitioner responses to the introduction and subsequent removal of stricter pay-for-performance targets for blood pressure control

  • Oriane Bodson, University of Liege, Belgium: Are pilot programmes able to give rise to sustainable health system effects? The case of performance-based financing in Benin

  • Christos Grigoroglou, University of Manchester, UK: The association between a primary care pay-for-performance scheme and suicide in England: a spatial cohort study

  • Discussant: Tim Doran, University of York, UK

Who is the session aimed at?

The event is targeted at academics researching P4P in high and LMIC settings as well as policy makers, funders and implementers from these settings.


Who is the session supported by?

The workshop is supported by the PEMBA: Performance-based financing mechanisms for health system strengthening in Africa project, funded by the MRC, ESRC, DfID and the Wellcome Trust, the Institute of Global Health Innovation at Imperial College London, Health, Organisation and Policy Economics at the University of Manchester and the RESYST Consortium.