Performance-based payment to improve the impact of health services: evidence from Haiti.

Holding health institutions accountable for achieving explicitly defined results by linking reimbursement to results can be a powerful strategy to improve health system performance. In Haiti USAID introduced performance-based payment as the mechanism to pay nongovernmental organizations after a population-based survey identified poor performance in NGO services. Examples of poor performance included immunization coverage of 7% and contraceptive prevalence rates as low as 6%. Rather than the previous system that reimbursed NGOs for documented expenditures up to a ceiling performance increase targets were established and a portion of the historically funded budget received by NGOs was withheld. NGOs had the opportunity to earn back the withheld amount plus a bonus if these performance targets were reached. This pilot study which involved three NGOs for one year showed marked improvements in immunization coverage and positive changes in organizational behavior. (authors)