Giving Compass' Take: 

• Yogesh Rajkotia criticizes the practice of "patient tracing," which can be motivated by performance-based financing, arguing that it violates people's privacy. 

• Are PBFs solely to blame, or is this a symptom of a larger issue? How can funders incentivize outcomes without exposing sensitive information?

• Bottom line: global health practitioners should be more mindful. It applies especially to areas of gender equality, as you can read here.

In 2013, in southern Mozambique, foreign NGO workers searched for a man whom the local health facility reported as diagnosed with HIV. The workers aimed to verify that the health facility did indeed diagnose and treat him. When they could not find him, they asked the village chief for help. Together with an ever-growing crowd of onlookers, the chief led them to the man’s home. After hesitating and denying, he eventually admitted, in front of the crowd, that he had tested positive and received treatment. With his status made public, he now risked facing stigma, discrimination, and social marginalization. The incident undermined both his health and his ability to live a dignified life.

Similar privacy violations were documented in Burkina Faso in 2016, where community workers asked partners, in the presence of each other, to disclose what individual health services they had obtained.

Why was there such a disregard for the privacy and dignity of these citizens?

As it turns out, unbeknownst to these Mozambican and Burkinabé patients, their local health centers were participating in performance-based financing (PBF) programs financed by foreign assistance agencies. Implemented in more than 35 countries, PBF programs offer health workers financial bonuses for delivering priority health interventions. To ensure that providers do not cheat the system, PBF programs often send verifiers to visit patients’ homes to confirm that they have received specific health services. These verifiers are frequently community members (the World Bank callously notes in its “Performance-Based Financing Toolkit” that even “a local soccer club” can play this role), and this practice, known as “patient tracing,” is common among PBF programs. In World Bank-funded PBF programs alone, 19 out of the 25 PBF programs implement patient tracing. Yet the World Bank’s toolkit never mentions patient privacy or confidentiality. In patient tracing, patients’ rights and dignity are secondary to donor objectives.

Read the full article about global development's problem with patient privacy by Yogesh Rajkotia at Stanford Social Innovation Review.