Alex Ergo and Ligia Paina
Verification in Performance-based Incentive (PBI) schemes aims to ensure that reported data accurately reflects actual performance, both by detecting and correcting misreporting, and by identifying and deterring fraud. In doing so, PBI verification guarantees the credibility of the scheme so that the different stakeholders trust that the performance that is being reported and rewarded is real. In lowand middle-income countries (LMICs), PBI verification is typically designed and implemented in environments with weak information systems, characterized by poor data availability, transmission, and information culture, and with low levels of implementation capacity. This context leads to considerable heterogeneity in how LMICs design and implement PBI verification. Furthermore, PBI verification is dynamic and tends to evolve over time, particularly as schemes move from pilot phase to national scaleup and as the behavior of PBI actors (e.g. service providers, district health teams) changes in response to the introduction of financial incentives. However, details about how verification systems evolve, along with the trade-offs that must be made along the way, are seldom documented.
This report contributes to this gap by summarizing lessons learned on how performance is verified in the context of health sector PBI in LMICs, based on the experience of six purposefully selected PBI schemes (Benin, Burundi, Kenya, Liberia, Rwanda, and Tanzania). The report is intended to serve as a guide for designers, implementers, and stakeholders, by providing lessons about the trade-offs to consider in the selection and refinement of key verification system features.