Pay for Performance for Improved Health in Burundi

P4P in BurundiDr. Jean-Francois Busogoro and Alix Beith

To increase utilization of health services and improve maternal and child health outcomes, Burundi is in the process of rolling out a publicly funded supply-side pay-for-performance (P4P) program nationwide consisting of payments to health facilities. Interesting features of this program include use of monthly quantity-related incentive payments (based on service utilization) and quarterly quality-related payments (measured partially through patient and community satisfaction) and a degree of facility-level autonomy to determine what to invest in and how to share payments among staff. This case study describes the P4P pilot scheme in Burundi, how the pilot influenced design of nationwide scale-up of P4P, and offers lessons for countries that are considering implementing similar government-led nationwide schemes.

(Available on the Health Systems 20/20 <;  website)