Using pay for performance incentives (P4P) to improve management of suspected malaria fevers in rural Kenya: a cluster randomized controlled trial

Menya, Diana; Platt, Alyssa; Manji, I; Sang, Edna; Wafula, Rebeccah; Ren, Jing; Cheruiyot, Olympia; Armstrong, Janice; Neelon, Brian; O’Meara, Wendy Prudhomme

doi:10.1186/s12916-015-0497-y

Cited by 18 publications

(26 citation statements)

References 35 publications

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“…Providing a DHIS2 implementation package to private sector health facilities that includes training, standardized reporting tools and software support might have a similar positive impact as realized in the public sector. Performance-based incentives might also be considered; private health facilities are likely to be motivated by facility-based incentive programmes that give them an opportunity to earn additional resources [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Completeness of malaria indicator data reporting via the District Health Information Software 2 in Kenya, 2011–2015

Githinji

Oyando

Malinga

et al. 2017

Malar J

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BackgroundHealth facility-based data reported through routine health information systems form the primary data source for programmatic monitoring and evaluation in most developing countries. The adoption of District Health Information Software (DHIS2) has contributed to improved availability of routine health facility-based data in many low-income countries. An assessment of malaria indicators data reported by health facilities in Kenya during the first 5 years of implementation of DHIS2, from January 2011 to December 2015, was conducted.MethodsData on 19 malaria indicators reported monthly by health facilities were extracted from the online Kenya DHIS2 database. Completeness of reporting was analysed for each of the 19 malaria indicators and expressed as the percentage of data values actually reported over the expected number; all health facilities were expected to report data for each indicator for all 12 months in a year.ResultsMalaria indicators data were analysed for 6235 public and 3143 private health facilities. Between 2011 and 2015, completeness of reporting in the public sector increased significantly for confirmed malaria cases across all age categories (26.5–41.9%, p < 0.0001, in children aged <5 years; 30.6–51.4%, p < 0.0001, in persons aged ≥5 years). Completeness of reporting of new antenatal care (ANC) clients increased from 53.7 to 70.5%, p < 0.0001). Completeness of reporting of intermittent preventive treatment in pregnancy (IPTp) decreased from 64.8 to 53.7%, p < 0.0001 for dose 1 and from 64.6 to 53.4%, p < 0.0001 for dose 2. Data on malaria tests performed and test results were not available in DHIS2 from 2011 to 2014. In 2015, sparse data on microscopy (11.5% for children aged <5 years; 11.8% for persons aged ≥5 years) and malaria rapid diagnostic tests (RDTs) (8.1% for all ages) were reported. In the private sector, completeness of reporting increased significantly for confirmed malaria cases across all age categories (16.7–23.1%, p < 0.0001, in children aged <5 years; 19.4–28.6%, p < 0.0001, in persons aged ≥5 years). Completeness of reporting also improved for new ANC clients (16.2–23.6%, p < 0.0001), and for IPTp doses 1 and 2 (16.6–20.2%, p < 0.0001 and 15.5–20.5%, p < 0.0001, respectively). In 2015, less than 3% of data values for malaria tests performed were reported in DHIS2 from the private sector.ConclusionsThere have been sustained improvements in the completeness of data reported for most key malaria indicators since the adoption of DHIS2 in Kenya in 2011. However, major data gaps were identified for the malaria-test indicator and overall low reporting across all indicators from private health facilities. A package of proven DHIS2 implementation interventions and performance-based incentives should be considered to improve private-sector data reporting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1973-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Completeness of malaria indicator data reporting via the District Health Information Software 2 in Kenya, 2011–2015

Githinji

Oyando

Malinga

et al. 2017

Malar J

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“…For example, a P4P scheme in Afghanistan incentivised the number of ante-natal and post-natal consultations done [10] and a P4P scheme in Benin paid providers according to the number of curative consultations completed [38]. A P4P scheme in Kenya rewarded measures of process quality of care, including the proportion of patients correctly given antimalarial drugs (based on test results) [39]. Indicators of structural quality of care were rewarded in 11schemesfor instance, the availability of waste management and infection control equipment in a P4P scheme in Zimbabwe [40].…”

Section: Design Of P4p Schemes In Lmicsmentioning

confidence: 99%

“…For instance in the P4P scheme in Pwani Tanzania [54], up to a quarter of the bonuses could be used at the facility-level to purchase drugs and supplied or undertake minor renovations, with the remainder to be used for salary top ups. We only identified two schemes in which resources could exclusively be spent on facilities' operational budgeta P4P scheme in Kenya's Rift Valley [39] and the Service Delivery Integration Programme in Malawi [14].…”

Section: How Is Performance Incentivised?mentioning

confidence: 99%

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Kovacs

Powell‐Jackson

Kristensen

et al. 2020

BMC Health Serv Res

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Background: Pay for performance (P4P) schemes provide financial incentives to health workers or facilities based on the achievement of pre-specified performance targets and have been widely implemented in health systems across low and middle-income countries (LMICs). The growing evidence base on P4P highlights that (i) there is substantial variation in the effect of P4P schemes on outcomes and (ii) there appears to be heterogeneity in incentive design. Even though scheme design is likely a key determinant of scheme effectiveness, we currently lack systematic evidence on how P4P schemes are designed in LMICs. Methods: We develop a typology to classify the design of P4P schemes in LMICs, which highlights different design features that are a priori likely to affect the behaviour of incentivised actors. We then use results from a systematic literature review to classify and describe the design of P4P schemes that have been evaluated in LMICs. To capture academic publications, Medline, Embase, and EconLit databases were searched. To include relevant grey literature, Google Scholar, Emerald Insight, and websites of the World Bank, WHO, Cordaid, Norad, DfID, USAID and PEPFAR were searched. Results: We identify 41 different P4P schemes implemented in 29 LMICs. We find that there is substantial heterogeneity in the design of P4P schemes in LMICs and pinpoint precisely how scheme design varies across settings. Our results also highlight that incentive design is not adequately being reported on in the literaturewith many studies failing to report key design features. Conclusions: We encourage authors to make a greater effort to report information on P4P scheme design in the future and suggest using the typology laid out in this paper as a starting point.

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“…However, merely listing practices to avoid does not solve the LVC problem (12). Other types of interventions that have been studied include clinical decision support (13), provider feedback (14), educational interventions for clinicians (15) and patients (16), and nancial incentives (17). In their systematic review, Colla et al (18) found that the most common intervention was clinical decision support and showed that there is considerable evidence for the effectiveness of clinical decision support and provider feedback.…”

Section: Different Attempts Have Been Made To Decrease the Use Of Lvcmentioning

confidence: 99%

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

Ingvarsson

Augustsson

Hasson

et al. 2020

Preprint

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Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected based on their level of prescription of three low-value lab tests (e.g., erythrocyte sedimentation rate, aspartate transaminase, vitamin D). FGDs were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or emotions to calm. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

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Using pay for performance incentives (P4P) to improve management of suspected malaria fevers in rural Kenya: a cluster randomized controlled trial

Cited by 18 publications

References 35 publications

Completeness of malaria indicator data reporting via the District Health Information Software 2 in Kenya, 2011–2015

Completeness of malaria indicator data reporting via the District Health Information Software 2 in Kenya, 2011–2015

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Why Do They Do It? A Grounded Theory Study of the Use of Low-value Care Among Primary Health Care Physicians

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