Evaluations of performance-based incentives in community-based family planning programmes
| Study reference/country/programme (study dates) | Study design | Findings | Conclusions/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 without | Acceptance 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 Columbia/Profamilia (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 |
| Klitsch21 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 children | There was evidence that self-employed agents targeted lower-income men and women, who were more likely to give a monetary reason for being sterilised | Investigators 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 commodities | ISMPs who started selling commodities reported substantial increase in FP counselling | Qualitative 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.