Send to

Choose Destination
Stud Fam Plann. 2016 Dec;47(4):309-324. doi: 10.1111/sifp.12001. Epub 2016 Nov 17.

Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review.

Author information

Claire Blacklock is Lecturer in International Public Health, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK and Honorary Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ekelechi MacPepple is Research Fellow, Department of Health Care Policy and Management, University of Surrey, Surrey, UK.
Setor Kunutsor is Research Fellow, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Southmead Road, Bristol, UK.
Sophie Witter is Professor, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.


Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center