Table 1

Evaluations of performance-based incentives in community-based family planning programmes

Study reference/country/programme (study dates)Study designFindingsConclusions/notes
Chang et al.15
Taiwan/Maximum Acceptance Study (Summer 1971)
Cross-sectional comparison of 20 counties, 10 randomly selected with field worker incentives and 10 withoutAcceptance rate of IUD among incentive areas was 9.0% compared to 2.9% in non-incentive areas
Acceptance rate of all methods (IUD, pill, condom) was 20.7% in incentive areas compared to 10.7% in non-incentive areas
Immediate monetary incentives for full-time field workers may produce better results in FP acceptance in a short period
Phillips et al.17
Philippines/Philippine Commission on Population (POPCOM)
(March 1973–August 1973)
90 motivators under four-arm study:
A Control with salary and quota point system
B Lower base salary with individual performance bonus
C Lower base salary with group performance bonus
D Per FP acceptor rate
Mean total adjusted points: A=41.9, B=67.2, C=48.0, D=97.1 with only Group D having statistically significant differences from controls
Salary cost per CYP: A=9.05, B=4.94, C=5.42, D=4.15
Overall, found that the per-FP acceptor rate approach was more successful and efficient than the use of salary with quotas or base salaries with performance bonuses
Porapakkham et al.19
Thailand/Field workers
(November 1971–October 1972)
39 workers under three-arm study:
A Full-time salaried workers
B Lower full-time salary plus incentive bonus
C Part-time volunteers with expense payments
Compared percentage of non-FP users recruited by each arm: A=25%, B=18%, C=32%
Compared number of new FP acceptors per 1000 eligible per month of field work: A=1.57, B=1.49, C =2.15
Authors write that Type B (incentive group) performed poorly compared to others due to confusing incentive structure, where performance bonus was based on relative performance to others in same field during same time period
Vernon et al.18
(April 1984–March 1986)
Three CBD supervisors serving 70 CBD posts in 50 counties with population of 585 500
Cost-effectiveness study of introducing sales commission over minimum sales goals and before and after analysis of prevalence
Cost of wage incentives programme was US$4.20 CYP
Prevalence of contraceptive use did not change substantially from baseline to endline for the areas with wage incentives; however, unmet need for contraception was reduced
The incentive programme did not appear to result in an increase in use of contraceptives
Bangladesh/self-employed community agents and midwives (1987)
Qualitative interviews and focus group discussions with men and women who had been sterilised, along with non-sterilised controls matched by location, family size, and desire to have no more childrenThere was evidence that self-employed agents targeted lower-income men and women, who were more likely to give a monetary reason for being sterilisedInvestigators recommended ending referral fees for sterilisation, which Bangladesh discontinued in 1988
Luoma et al.16
India/ISMP (1999)
Qualitative interviews of 49 ISMPs after training to sell FP commoditiesISMPs who started selling commodities reported substantial increase in FP counsellingQualitative responses indicate that financial incentive of sales commissions is the primary motivating factor for increasing FP counselling
  • CBD, community-based distribution; CYP, cost per couple protection year; FP, family planning; ISMP, indigenous systems of medicine practitioners; IUD, intrauterine device.