Evaluation of a pay for performance programme in Pwani region in Tanzania: A controlled before and after study, IMPACT

Resource Type
  • Borghi, Josephine (Ifakara Health Institute, London School of Hygiene and Tropical Medicine)
  • Mamdani, Masuma (Ifakara Health Institute)
  • Abdulla, Salim (Ifakara Health Institute)
  • Mayumana, Iddy (Ifakara Health Institute)
  • Mashasi, Irene (Ifakara Health Institute)
  • Binyaruka, Peter (Ifakara Health Institute)
  • Patouillard, Edith (Ifakara Health Institute, London School of Hygiene and Tropical Medicine)
  • Njau, Ikunda (Ifakara Health Institute)
  • Maestad, Ottar (Norway Chr. Michelsen Institute)
Publication Date
Publication Place
Free Keywords
Pay for performance, Impact evaluation, Tanzania
  • Abstract

    Background: The use of supply-side incentives to increase health service utilisation and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is a paucity of evidence on the impact of such schemes, their cost-effectiveness, and the process of implementation and potential unintended consequences in these settings. A pay for performance (P4P) programme was introduced in Pwani region of Tanzania in 2011. Methods/design: An evaluation of the programme will be carried out to inform a potential national rollout. A controlled before and after study will examine the effect of the P4P programme on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. Data will be collected from a survey of 75 facilities, 750 patients exiting consultations, over 75 health workers, and 1,500 households of women who delivered in the previous year, in all seven intervention districts. Data will be collected from the same number of respondents in four control districts. A process evaluation will examine: whether the P4P programme was implemented as planned; stakeholder response to the programme and its acceptability; and implementation bottlenecks and facilitating factors. Three rounds of process data collection will be conducted including a review of available P4P documents, individual interviews and focus group discussions with key informants working at facility and district level in five of the intervention districts, and at the regional and national levels. An economic evaluation will measure the cost-effectiveness of P4P relative to current practice from a societal perspective. Discussion: This evaluation will contribute robust evidence on the impact and cost-effectiveness of P4P in a low income setting, as well as generate a better understanding of the feasibility of integrating complex intervention packages like P4P within health systems in resource poor settings. 

Temporal Coverage
  • 2012
Collection Mode
  • Face-to-face interview
Not available

Update Metadata: 2015-10-09 | Issue Number: 6 | Registration Date: 2015-10-09