Columbia International Affairs Online: Working Papers

CIAO DATE: 05/2008

Performance-Based Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion? - Working Paper 122

Alexandra Beith, Rena Eichler, Diana Weil

April 2007

Center for Global Development


Tuberculosis (TB) remains a lethal public health threat. In 2005, the World Health Organization estimated that 1.7 million people died from TB and nearly 9 million developed the disease. Ninety-eight percent of those deaths occured in the developing world. This paper analyzes the use of financial and material incentives for patients and healthcare providers to improve tuberculosis detection and successful completion of treatment. Incentives, which can include money, food and other material goods, directed toward patients are conditional on completing steps in the treatment process to ensure adherence to the lengthy treatment schedule. Incentives directed at providers seek to improve the quality of diagnosis, expand access to treatment, and improve teamwork.

The authors find that while managing the distribution of money and food can be complicated, performance-based incentives for patients and providers contribute to increases in TB case detection and treatment completion. They offer recommendations for improving future programs, including:

This paper is one in a series of four CGD working papers written in conjunction with the Performance-Based Incentives Working Group (Working Paper Nos. 119 – 122).