Pay for performance (P4P), consisting of bonuses to health facilities linked to attainment of performance targets, is being implemented in the United Republic of Tanzania with the goal of improving maternal and child health outcomes; strengthening information systems and the use of information for management decisions; and motivating health care providers. After discussions between the government of Tanzania and development partners, the government chose to implement a nationwide P4P program. This decision – to begin on a national scale rather than with a pilot – along with donor concerns about weaknesses in the program, resulted in development partners declining to fund the bonuses out of the health basket. This case study explores the process between donors and the government of moving P4P from concept to design to implementation. It describes key areas of disagreement, and highlights the political tensions inherent in translating high-level interest in P4P into on-the-ground action.
(Available on the Health Systems 20/20 <http://www.healthsystems2020.org/files/2596_file_Tanzania_P4P_Brief.pdf> website)