Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review

Abstract

Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.

Evaluating Quality of Contraceptive Counseling: An Analysis of the Method Information Index

“…Here, results of FP counseling can be used to adjust training curricula or to provide results‐based payments, where financing is linked to agreed‐upon targets and payment is only made once targets are achieved (Blacklock et al. ). In these situations, verification of the MII findings, even in a subsample of clients, is advised.…”

Rwandan stakeholder perspectives of integrated family planning and HIV services

“…26 However, differentiated reimbursement schemes, proportional to the time and costs that clinics incur to provide LARC methods, have been considered and implemented in other locales, for example in Burundi where the payment for new oral and injectable FP users and all return clients was $2.00USD, while for implants/IUDs it was $5.00USD. 27,28 The importance of male involvement, already a nationwide norm with joint HIV testing of >80% of pregnant women and their partners, 9 was also mentioned as an important means of increasing effective LARC use.…”

Systematic Reviews of Mechanisms for Financing Family Planning: Findings, Implications, and Future Agenda

“…); (iv) results‐based financing (Blacklock et al. ), including all interventions involving payment for performance that have a supply‐side component; and (v) social protection programs that provided a voucher (Bellows et al. ) subsidy to disadvantaged clients and reimbursed healthcare workers for providing contraceptive services at a pre‐defined quality standard, including referral vouchers.…”

“…Five intervention groups were identified, and for each a specific systematic review was carried out. The specific interventions groups were: (i) introduction of community financing and community-based health insurance (Karra et al 2016), which included interventions for family planning that focus on the role of the community in mobilizing, pooling, and allocating reproductive health resources through various health financing instruments, including micro-insurance, microfinance and microcredit, mutual health organizations, and community-managed user fees; (ii) introduction of conditional and unconditional cash transfers (Khan et al 2016); (iii) introducing, removing, or changing out-of-pocket payments or user fees (Korachais et al 2016); (iv) results-based financing (Blacklock et al 2016), including all interventions involving payment for performance that have a supply-side component; and (v) social protection programs that provided a voucher (Bellows et al 2016) subsidy to disadvantaged clients and reimbursed healthcare workers for providing contraceptive services at a pre-defined quality standard, including referral vouchers. Social marketing and franchising were not included as these were examined by other recent systematic reviews (Sweat et al 2012;Westley and Shochet 2013).…”