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An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial.

Publication ,  Journal Article
Menya, D; Logedi, J; Manji, I; Armstrong, J; Neelon, B; O'Meara, WP
Published in: Implement Sci
May 8, 2013

BACKGROUND: In high-resource settings, 'pay-for-performance' (P4P) programs have generated interest as a potential mechanism to improve health service delivery and accountability. However, there has been little or no experimental evidence to guide the development or assess the effectiveness of P4P incentive programs in developing countries. In the developing world, P4P programs are likely to rely, at least initially, on external funding from donors. Under these circumstances, the sustainability of such programs is in doubt and needs assessment. METHODS/DESIGN: We describe a cluster-randomized controlled trial underway in 18 health centers in western Kenya that is testing an innovative incentive strategy to improve management of an epidemiologically and economically important problem--diagnosis and treatment of malaria. The incentive scheme in this trial promotes adherence to Ministry of Health guidelines for laboratory confirmation of malaria before treatment, a priority area for the Ministry of Health. There are three important innovations that are unique to this study among those from other resource-constrained settings: the behavior being incentivized is quality of care rather than volume of service delivery; the incentives are applied at the facility-level rather than the individual level, thus benefiting facility infrastructure and performance overall; and the incentives are designed to be budget-neutral if effective. DISCUSSION: Linking appropriate case management for malaria to financial incentives has the potential to improve patient care and reduce wastage of expensive antimalarials. In our study facilities, on average only 25% of reported malaria cases were confirmed by laboratory diagnosis prior to the intervention, and the total treatment courses of antimalarials dispensed did not correspond to the number of cases reported. This study will demonstrate whether facility rather than individual incentives are compelling enough to improve case management, and whether these incentives lead to offsetting cost-savings as a result of reduced drug consumption. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number NCT01809873.

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Published In

Implement Sci

DOI

EISSN

1748-5908

Publication Date

May 8, 2013

Volume

8

Start / End Page

48

Location

England

Related Subject Headings

  • Sample Size
  • Rural Health Services
  • Reimbursement, Incentive
  • Motivation
  • Malaria
  • Kenya
  • Humans
  • Health Policy & Services
  • Fever
  • Cluster Analysis
 

Citation

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Menya, D., Logedi, J., Manji, I., Armstrong, J., Neelon, B., & O’Meara, W. P. (2013). An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial. Implement Sci, 8, 48. https://doi.org/10.1186/1748-5908-8-48
Menya, Diana, John Logedi, Imran Manji, Janice Armstrong, Brian Neelon, and Wendy Prudhomme O’Meara. “An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial.Implement Sci 8 (May 8, 2013): 48. https://doi.org/10.1186/1748-5908-8-48.
Menya, Diana, et al. “An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial.Implement Sci, vol. 8, May 2013, p. 48. Pubmed, doi:10.1186/1748-5908-8-48.
Journal cover image

Published In

Implement Sci

DOI

EISSN

1748-5908

Publication Date

May 8, 2013

Volume

8

Start / End Page

48

Location

England

Related Subject Headings

  • Sample Size
  • Rural Health Services
  • Reimbursement, Incentive
  • Motivation
  • Malaria
  • Kenya
  • Humans
  • Health Policy & Services
  • Fever
  • Cluster Analysis