When designing effective provider incentives, a few challenges/issues stand out for resource-limited settings: the effective size of incentives compared to the relatively low compensation, the possibility of crowding out providers’ intrinsic motivations, the lack of existing mechanisms for performance evaluation, and the sustainability of any incentive programs.
My idea is to provide:
1) Team-based incentives tied to clearly-defined patient outcome targets;
2) Routine feedback reports that compare performance with regional averages.
Using HIV care in Africa as an example, a cash reward can be given to clinics quarterly for every patient with HIV still alive and on treatment 12 months after becoming eligible for ART. All staff members will participate in the decision on how to use the reward, whether to hire additional home visitors to improve retention or to take home as bonuses. Through guided staff meetings, clinics will be provided with quarterly reports on retention rate compared with other clinics in the area. Meanwhile, continuing medical education - absent in most rural clinics - could be delivered through these meetings.
This scheme will motivate providers to focus on treatment outcomes, encourage creativity, and boost team morale. After all, providers in these setting know the best what would work to improve quality of care if they are given adequate resources and tools. The scheme is also relatively easy to implement given the rollout of EMR systems.
Link leads to: http://www.thelancet.com/article/S0140-6736(11)60177-3/abstract
Link leads to: http://www.ncbi.nlm.nih.gov/pubmed/22336833
Link leads to: http://www.ncbi.nlm.nih.gov/pubmed/23521823
Link leads to: http://www.ncbi.nlm.nih.gov/pubmed/19930141
Link leads to: http://www.biomedcentral.com/1472-6963/11/266
Link leads to: http://www.ncbi.nlm.nih.gov/pubmed/16168785
Link leads to: http://www.ebrd.com/downloads/research/economics/workingpapers/wp0147.pdf