Community Engagement and Performance-based Incentives: The View From Burundi

Karishmah Bhuwanee and Lindsay Morgan

This case study, one in a series exploring community engagement and PBI, discusses the ways in which Burundi’s performance-based incentive (PBI) program has (or hasn’t) increased social accountability by contracting local community-based organizations to conduct verification and gauge patient satisfaction with services.

We describe the nuts and bolts of how this mechanism is implemented, and measure it against two essential elements of effective CE: access to information and channeling views/collective action.

The bottom line: combining bottom-up pressure and the top-down accountability strategy of PBI has significant potential to enhance social accountability, especially in a country like Burundi, where PBI has been institutionalized and scaled up. But CBO verification raises questions of independence and patient privacy, and engaging them does not necessarily foster community-wide empowerment and participation.

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