Improving PBF: Offering incentives that matter

Oct. 10, 2013 - PRLog -- Collaborative Development’s Kimberly Hirsh, MBA and Nancy Fitch, MD will host a panel presentation at the Global Health Workforce Alliance (GHWA) Forum on November 10^th, 2013 about how PBF mechanisms can be improved by offering incentive payments that make a difference in the lives and careers of employees.

“Many problems with healthcare in the developing world boil down to poor motivation,” says Ms. Hirsh. “What Collaborative Development is seeing on the ground is a ton of poorly motivated health workers, including health workers whose facilities are receiving PBF payments. We have noticed that in facilities that translate PBF benefits into things their employees actually want and value - those facilities drastically improve -- cleanliness, wait times, stock levels -- and so does the quantity and quality of health services.”

PBF, an increasingly popular alternative to traditional input-based financing, is designed to increase performance by offering incentive payments to individual healthcare facilities for achievement of pre-defined indicators. However, this approach often measures and rewards indicators only at the system and facility level; how the facility-level payment incentives are actually used and how they influence the motivation and performance of individual health workers can be seen as a black box. Ms. Hirsh and Dr. Fitch believe that cracking this black box is the key to making PBF truly successful.

“Incentive pay to healthcare facilities is great,” says Collaborative Development’s managing director Yogesh Rajkotia, “but if those payments aren’t used to invest in things that individual health workers value, they will not be motivated, and facility-level performance will only improve so much. Now, take that money and invest in things that are proven to spark intrinsic motivation, like better living conditions, opportunities for education and career advancement, quality job tools, and strong management, and you will see the quality and quantity of those facilities’ work skyrocket.”

Ms. Hirsh, Dr, Fitch, and panel members will present examples from their experiences implementing and evaluating PBF projects in Mozambique, Brazil and other countries, describing  how a well-designed PBF program can increase staff motivation, performance, retention, and health outcomes overall. They will lead what they hope will be a lively discussion about the benefits, costs, and risks of “PBF that reaches the individual,” and they will call for a global task force to further focus on promoting rigorous research and developing sound methodologies to tighten the link between PBF and intrinsic motivation of individual healthcare workers.

The GHWA forum that will host this panel discussion is a highly anticipated event under the patronage of the Government of Brazil, the World Health Organization (WHO), and the Pan American Health Organization (PAHO). Attendance will include senior-level government officials and representatives from donor institutions and multilateral agencies. This year’s theme: Human Resources for Health - the foundation for universal health coverage. To learn more about the GHWA Forum, go to  http://www.who.int/workforcealliance (http://www.who.int/workforcealliance/forum/2013/en/), and join the discussion online at http://ghwamembers.net/. If you’re in the region, attend the forum and lend your voice to the live discussion. Follow Collaborative Development’s work at http://www.collaborativedev.com.