• Service delivery (infrastructure, supply chains, health workforce, information systems)
• Policies and leadership (oversight, financing)
• Physical and social environment (cultural, population, geographic characteristics)
• Household and individual characteristics (household size, wealth, level of education; individual behaviors and biological factors)

Health systems strengthening (HSS) efforts are, therefore, woven into all the work that MCHIP does, across intervention areas. MCHIP aims to identify gaps, barriers and dysfunctional incentives in the health system that impede access to and/or supply of high-impact maternal, newborn and child health (MNCH) interventions, and to find innovative solutions. We also contribute to global leadership by generating interest in new approaches to HSS—such as innovative financing mechanisms—that strengthen health systems and improve the health of mothers and children.

Health Financing
One mechanism to change the incentive environment is through innovative health financing mechanisms, including performance based incentives (PBI). This term refers to any program that transfers money or goods to either patients when they take health-related actions (such as having their children immunized) or to healthcare providers, when they achieve performance targets (such as immunizing a certain percentage of children in a given area).

PBI alters the incentive environment to reward MNCH goals, such as increases in service utilization, improvements in the quality of services, and better reporting and data management to improve facility, district, and national planning and drug forecasting. Though no panacea, where PBI is being tried, evidence suggests that it motivates and empowers the health workforce; focuses attention on (and provides demonstrable evidence of) measurable results; strengthens information systems; builds local capacity to manage and deliver health services; and improves health outcomes.

To learn more, visit Health Systems 20/20 and Results-Based Financing for Health.

National Standards
MCHIP helps countries to develop essential clinical standards, guidelines and training materials that contribute to strengthening the quality of MNCH care. The Program works on national standards and curricula, and builds the capacity for the implementation (or strengthening) of effective Monitoring and Evaluation systems. 

Health Management Information Systems
MCHIP also advocates for the inclusion of new indicators in health management information systems at the global and national levels in order to strengthen the information systems that are essential in guiding decision-making, drug forecasting and other activities.

Country Programs
Incentivizing Quality in Malawi: 
MCHIP is improving quality in Malawi by reducing infections and increasing compliance with guidelines through national adoption of Jhpiego’s standards-based management and recognition (SBM-R) tool. To enhance uptake of SBM-R and the usefulness of the information the tool provides, MCHIP is introducing the SBM-R process, making use of handheld tablet computers. MCHIP is also leveraging funding from Norway and Germany to pilot PBI in five districts by collaborating to link modest financial awards to improvements in SBM-R results. 

PBI in Tanzania: 
MCHIP is providing technical assistance to design and operationalize a PBI pilot in the Coast region of Tanzania. The pilot will provide incentives to health facilities and council health management teams conditional on attainment of targets related to the quantity and quality of MNCH services.