Extending performance-based financing to community health workers

CLIENT: THE WORLD BANK

2019 

Can we bring strategic purchasing mechanisms to the community level, ensuring basic care is delivered closer to people?

CHALLENGE

Sustainably improve Burundi’s community-based nutrition and family planning services.

The World Bank sought solutions to bring contraceptive services into community settings, offering alternative approaches to increase acceptability and adherence, and integrating FP with existing community-based nutrition activities.

SOLUTION

Extend performance-based financing to community-level workers for integrated nutrition and family planning services.

Building on the successes of Burundi’s performance-based financing (PBF) initiative for clinical care, Impact for Health and local partners co-designed extension of PBF to engage new cadres of community health workers in the integrated delivery of contraception and nutrition care.

KEY INSIGHTS

Provider payment mechanisms can be extended to non-traditional providers.

Bringing care closer to patients through community health workers requires adaptations to existing health financing mechanisms. In this case, the design called for extension of PBF payments to peer workers called Model Mothers for basic contraceptive services.

Breaking down siloes between family planning and nutrition requires support from the top and alignment of incentives.

Successful expansion Model Mothers’ remit from nutrition services to include contraception depends on support from the nutrition program leadership and careful design of the PBF payment mechanisms.

Building on existing assets and financing systems supports acceptability and sustainability.

In addition, championing and scaling local solutions – implemented by local organizations – is key to achieving sustained impact in a complex political context.

Political economy analysis is critical to crafting actionable solutions.

Understanding how the political context could impact implementation of the design is critical to crafting strong recommendations.

“The PBF scheme is a real opportunity; it has improved the health indicators for FP and maternal health. Now we need to bring it to the community level”

Key informant, Ministry of Health

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