Resource Type: Report
Authors: Rena Eichler, Jenna Wright, Ben Bellows, Marie Cole, Victoria Boydell and Karen Hardee.
Published: September 2018

Resource Description: The past 20 years have seen unprecedented financial commitment to family planning (FP) among governments of low- and middle-income countries and the donors that support them. However, mobilizing government and external resources is often not enough to increase access to and voluntary use of FP services. Thus, some countries have begun to use strategic purchasing to shape the service delivery system. In these countries, the public or private purchaser(s) – for example, social health insurance funds, voucher management agencies, ministries of health (MOHs), or central procurement agencies – strategically purchase health services, sometimes from both public and private sectors, using payment systems intended to maximize value for money.

This guidance document concentrates on strategic purchasing systems that conditionally link a portion of payment to health facilities and their supervisors with the attainment of pre-specified FP outputs or outcomes. Systems such as these have alternately been labeled results-based financing (RBF), performance-based financing (PBF), performance-based incentives (PBI), and pay-for-performance (P4P). These types of strategic purchasing systems aim to motivate and hold providers and supervisors accountable for providing high-quality voluntary FP services.

This document identifies the opportunities for and challenges of incorporating voluntary FP into RBF systems that pay providers; offers considerations for establishing fees; describes approaches to monitoring and verification; discusses U.S. policies surrounding support for enhancing access to FP; presents what is known about how low- and middle-income countries are including FP; and provides suggestions for donors, policymakers, program implementers, and technical assistance providers about how to responsibly and effectively apply strategic purchasing to enhance FP results in LMICs.