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Table 1 Design of P4P schemes in LMICS (41 schemes in 29 LMICs)

From: How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Design featuresProportion of schemes [Number of schemes]
Measures of performance incentivised (N = 41) a
 Healthcare visits83% [34]
 Quality of care (process)66% [27]
 Health outcomes17% [7]
 Quality of care (structural)27% [11]
 Management practices22% [9]
 Efficiency5% [2]
Whose performance measured (N = 41) a
 Individuals26% [10]
 Groups of health workers3% [1]
 Health facility76% [31]
Health system managers5% [2]
 Who (ultimately) receives the payment (N = 38) a
 Individuals86% [32]
 Groups of health workers3% [1]
 Health facility46% [17]
 Health system managers10% [4]
Payment attributes
(N = 23)Frequency 
Monthly or weekly44% [10]
Bi-monthly or quarterly30% [7]
Every 6 months13% [3]
Annual or one-off13% [3]
(N = 11)Median size10% of monthly income
(N = 0)Lag time
(N = 41)Reward versus penalty 
Rewards98% [38]
Penalties2% [1]
(N = 3)Coupled payments 
Yes67% [2]
No33% [1]
(N = 34)Use of money 
Staff income56% [19]
Operating budget6% [2]
Both38% [13]
Basis for payment
(N = 32)Each action (e.g. visit) 
Yes72% [23]
No28% [9]
(N = 32)Threshold target (single target) 
Yes28% [9]
No72% [23]
(N = 32)Threshold target (multiple targets) 
Yes9% [3]
No91% [29]
(N = 41)Type of ranking 
Relative ranking (tournament)5% [2]
Own performance (absolute)76% [31]
Own performance (improvement)19% [8]
(N = 41)Payment adjustment 
Equity22% [9]
Quality19% [8]
None reported59% [24]
Gaming safeguards
(N = 41)Performance audit 
Yes (without penalties reported)61% [25]
Yes (with penalties)5% [2]
None reported34% [14]
  1. Note: a = multiple options possible