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To improve access to, and use of, facility-based obstetric and newborn care services in rural areas, the Government of Bangladesh is implementing two innovative performance-based financing programs: demand-side financing (DSF) and pay-for-performance (P4P). Both programs have contributed to the increase in institutional deliveries, yet not enough women receive the recommended care during pregnancy and delivery. DSF and P4P are implemented in parallel and have their own merits and limitations. As described in this brief, a two-day workshop was organized in 2011 in Dhaka to identify the lessons learned and limitations of P4P and DSF models and scopes for cross-learning. Both DSF and P4P were found to have the same goal but differ in approaches and outcomes. The main difference is that P4P implements a “quality of care”-based incentive mechanism for maternal, newborn, and child health (MNCH) care, which has the potential to improve monitoring of health-service delivery in rural areas of Bangladesh. The workshop resulted in several recommendations for modifying DSF and P4P schemes.






Pay-for-Performance (P4P) to Increase Use of Maternal, Neonatal, and Child Health Services in Bangladesh