There is growing interest internationally in the use of vouchers to incentivise health workers in order to improve the quality or efficiency of their care.
Working closely with the state ministries of health, PRRINN-MNCH designed and supported implementation of a rural access initiative which involved training commercial car drivers from the Nigerian National Union of Road Transport Workers (NURTW) to run a community-based emergency transport scheme (ETS) on a voluntary basis. The ETS was integrated with and implemented alongside a range of other community-based interventions which addressed the first delay (the delay in the decision to seek care). Seventy-two Local Government Areas were involved in the demand-side interventions, which reached a population of 7.6 million people. This was one of the largest and longest-lasting community-based maternal, newborn, and child health (MNCH) initiatives implemented in northern Nigeria.
With funding from The MacArthur Foundation, a pilot study to determine which incentives the volunteer drivers would like, and to assess whether these affected their performance levels, and hence the sustainability of the emergency transport scheme, was implemented. Key messages include:
- Incentives, both cash and in-kind, were associated with higher performance among drivers involved in a transport scheme for women in need of emergency maternal health care.
- Some incentives worked better than others. The selection of incentives should be based on what drivers want, and the process to obtain them needs to be simple and accessible.
- The provision of incentives did not appear to undermine the spirit of voluntarism among the drivers. Further research is needed into the long-term effects of incentives on volunteer activity.
Study leaders: Sally E. Findley, Ismail Balogun, and Godwin Afenyadu. PRRINN-MNCH Operations Research Unit: Ashiru Garba (Yobe), Safiyanu Manii (Katsina), Charles Uzondo (Jigawa), and Musa Kana (Zamfara).
This brief compiled by Cathy Green, Health Partners International