Annual Performance-Based Financing Bonus Payments Motivate Local NGOs in Haiti

One of the representatives from a local NGO that met all the targets and received the annual bonus payment. {Kate Dilley/MSH.}Kate Dilley/MSH.

Management Sciences for Health’s (MSH) USAID-funded Santé pour le Développement et la Stabilité d’Haïti (SDSH) Project and its all-Haitian staff are working through a network of 27 nongovernmental organizations (NGOs) using performance-based financing contracts to provide primary health care—with a focus on maternal, newborn, and child health, HIV & AIDS services, and family planning services—to nearly half of Haiti’s population.

MSH establishes contracts with the NGOs to meet an established and agreed upon set of targets prior to release of funds. This health financing mechanism is a proven way to reinforce innovation, results, and accountability. SDSH works with the NGOs to support decentralization and strengthen capacity to provide high quality health care services in Haiti.

On January 7, 2011, annual bonus payments were paid to the NGOs. The annual bonus payment is paid out to the NGOs if they meet their agreed upon targets and is one of the key motivational factors for the NGOs in this network. This payment can be used to pay health workers an individual bonus, make infrastructure improvements to their facility, or procure other items for the health facilities. At the end of each contracting period the NGOs are required to randomly select indicators from each health area (maternal newborn child health, HIV & AIDS, family planning) on which their annual bonus payment will be based. Twelve of the 27 NGOs sent representatives to the MSH/Haiti office to select their indicators.

Indicators were printed and then cut out and folded into individual envelopes for each NGO to randomly select. The representatives met with the monitoring and evaluation team to pick the indicators, validate their results, sign their agreements, and begin the payment process.

Through this annual bonus payment process it is clear that performance-based financing has had a marked impact on the Haitian NGOs and their ability to provide high quality, well managed, health care.

SDSH provides technical support to the NGOs when needed, including helping NGOs draft plans to get back on track for missed targets. One of the NGOs missed their HIV & AIDS targets, but with support from SDSH, it was determined that the missed target was due to the cholera epidemic and the inability to provide HIV tests. The clinic then established a separate place to provide HIV tests effectively.

Association d’entre-aide des dame-mariens (AEADMA) is one of the NGOs supported by SDSH. AEADMA met all of their targets for 2010, and thus received 100% of their bonus payment. AEADMA constantly works to improve their management, making sure that all staff and employees meet their targets. “PBF has developed a culture of results. The challenge is to always be among the well performing organizations,” said Pierre Michel Antoine, an AEADMA employee.

AEADMA holds individual staff members accountable through monthly update meetings, to track progress and see where individual health care workers are having trouble.

The SDSH project, funded by USAID and implemented by MSH, supports 27 NGOs in Haiti’s 10 Departments (districts) to deliver an integrated package of primary health services in 147 fixed health facilities (service delivery points) and in the communities surrounding the health facilities. SDSH supports over 1,500 community health workers, and over 4,000 trained community-based traditional birth attendants.

SDSH is an MSH-led collaboration of Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs (CCP), AIDS Healthcare Foundation (AHF), JHPIEGO, and Foundation pour la Sante Reproductrice et l’Education Familiale (FORSREF) with USAID, the Government of Haiti, local NGOs, community leaders, and the commercial private sector.

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