Engaging and empowering communities to enhance accountability is a growing trend in the health sector, mirroring a growing interest in health sector governance more broadly. This guide aims to help policymakers and program managers assess whether engaging communities makes sense in the context of the performance-based incentive (PBI) programs they support; determine what is the best approach or mechanism for such engagement; and how to mitigate the risks. PBI, as with bottom-up social accountability mechanisms, aims to fix broken accountability relationships by providing payers of health services tools to hold providers accountable through provision of incentives for verified increases in the quantity and quality of health services.
Lessons and recommendations in the guide are based on part on detailed research conducted in three countries implementing very different PBI programs: Burundi, Indonesia and Mexico. Among the challenges highlighted in this guide is the need to balance cost savings with ensuring these important functions are robust. There are risks of elite capture and exclusion, and tensions between the goals of Community Engagement– for example, the desire for Community Engagement to be inclusive and representative – and the needs of the programs, which requires individuals and entities with skills, experience, and independence/objectivity.