Huseinagic, SenadStevic, SinisaBirungi, CharlesChukwuma, Adanna2024-01-052024-01-052024-01-05https://openknowledge.worldbank.org/handle/10986/40849This report outlines a strategic approach to introduce pay-for-performance (P4P) incentives for improved noncommunicable disease (NCD) care in Republika Srpska (RS) and the Federation of Bosnia and Herzegovina (FBiH). Developed under the context of the Functional Review of Health Systems’ Performance Program financed by the European Union and implemented by the World Bank Group, it intends to provide initial framework for methodological documents to be supported by the Health Systems Improvement Project (HSIP), focusing on evidence-based, technically sound, and politically feasible strategies. Participatorily developed, the report synthesizes global lessons and analyzes the policy environment in RS and FBiH. It proposes key design features, addressing strategic opportunities and operational challenges. Behavioral economics insights and political economy factors inform the approach, identifying key levers, opportunities, and challenges affecting P4P implementation capacity. To enhance NCD care quality, the report recommends changes in the provider payment mix, tailored reforms at entity and cantonal levels, and active service user engagement. Emphasizing the importance of linking payment incentives to performance, the proposed design spans dimensions such as performance measures, basis of payment, payment attributes, recipient of payment, and targeted outcomes. An enabling environment is deemed critical. Relatedly, effective implementation requires robust data systems, stakeholder engagement, adapted legal frameworks, and suitable institutional arrangements. Technical assistance and budgetary support needs are identified. It is expected that P4P implementation will enhance NCD care coverage and quality, thereby improving health outcomes and overall health system performance in RS and FBiH.en-USCC BY-NC 3.0 IGOHEALTH FINANCINGQUALITY OF CAREPAY-FOR-PERFORMANCENONCOMMUNICABLE DISEASEBOSNIA AND HERZEGOVINAGOOD HEALTH AND WELL-BEINGSDG 3Working PaperWorld Bank10.1596/40849