Concern about assuring that the Haitian population had access to basic health services motivated USAID to fund a project in 1995 to deliver essential services, while strengthening the management of the organizations providing them. When the project began, immediate needs required that the project develop rapid mechanisms to fund NGOs so they could provide critical basic health services, including maternal and child health, reproductive health, and family planning services, to Haiti’s population. Initially, NGOs were reimbursed for documented expenditures up to a ceiling that was essentially a negotiated budget. The vision of the project was to develop the capacity of NGOs to eventually receive payment based on services provided (outputs). The challenge was to develop a system that moved toward attainment of project and health system goals without imposing excessively burdensome monitoring and reporting requirements. The strategy to realize this transformation combined technical assistance to NGOs, creation of a learning and exchange network, and a change in payment structure from reimbursement for documented expenditures to payment based partly on whether performance targets were achieved.
Starting in 1999 with a pilot managed by Management Sciences for Health (MSH), payment to 3 contracted NGOs changed from reimbursement for documented expenditures to payment partly determined by whether performance targets are reached. Strong performance suggested that this approach should be expanded to other NGOs. Now reaching 2.7 million people, NGOs in the project network provide essential services to the Haitian population.
Promising results from this pilot caused USAID and MSH to integrate payment for results into future phases of the project. Subsequent phases progressively added additional NGOs and experimented with changes in design and implementation. By 2006, all NGOs supported by the program are involved in this strategy, which has also been adapted to fund the public sector.