Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs

This chapter surveys experience with performance pay in developing country health programs. In doing so, it focuses on four key conceptual issues: (1) What to reward, (2) Who to reward, (3) How to reward, and (4) What unintended consequences might performance incentives create. We highlight that the use of performance pay has outpaced growth in corresponding empirical evidence. Moreover, very little research on performance incentives focuses on the underlying conceptual issues that we outline. We consider these to be important constraints to the design of better performance incentives in low- and middle-income country health programs.