British Academy Newton Advanced Fellowship project
CHSS University of Kent
London Seminar


15th September 2020, 13:00-17:00, University of London Senate House (1st Floor, Room G3), Malet Street, Bloomsbury, London WC1E 7HU


REGISTRATION NEEDED - Entrance free. Capacity: 26 attendees and 14 participants/collaborators. Make your registration to guarantee your place. Registration needed at



London Seminar P4P BANNER



This event is supported by a British Academy Newton Advanced project studying the formulation and implementation process of a Brazilian payment for performance programme (The PMAQ) and its impact on performance drivers and system strengthening. Results show that PMAQ was not highly successful in terms of workforce and leadership strengthening due, for instance, to lack of knowledge, motivation, participation and feedback at the frontline of primary care in Brazilian municipalities. Given the fact that Brazil has launched a new pay for performance programme (in mid-November 2019) inspired in the English “Quality and Outcome Framework” (the QOF), this event consists of an opportunity for policymakers, researchers and general audience to discuss payment for performance programmes in both countries, taking into account their similarities and distinctiveness in primary care.

A main comparative question to be discussed is: How can lessons from England be transferred to Brazil? The seminar is organised in three sessions. The English QOF will be discussed in the first session, considering the development of and changes in the QOF during the decades. The second session will discuss the main guidelines of the new Brazilian programme with respect to its payment for performance component, as well as lessons related to challenges in the Brazilian primary care scenario and lessons extracted from the previous pay performance programme (The PMAQ). The final session will suggest variables- and case-driven comparative analyses of primary care and payment for performance in PHC in both countries and extract illustrative and synthesis lessons on how could Brazil possibly learn from the English QOF.  


Specific questions guiding discussions

In the first session we will be discussing QOFs policymaking and implementation process during the decades, trying to understand how changes, for instance, in policy relevant issues and indicators, as well as motivation/engagement at the frontline has taken place. Among the QOF-related questions that will be discussed and could be used to guide the monitoring and evaluation process of the new Brazilian programme are: why has the number of QOF indicators been reduced? Why and how qualitative improvement indicators are now being considered as an important shift in the process? What is the role to be placed or taking place by the network of GPSs and to what extent it might impact policymaking? Can we say that we might be witnessing a change in the policymaking process related to the QOF? What are the main changes taken place in GPs motivations during the decades, and how did they happen? What are the main political/ policy concerns related to the future of QOF in England?

Relevant questions to be asked from the Brazilian side might be: What are the main new changes/strategies planned in the new programme (Prevent Brazil) in order to avoid the same issues happened during PMAQ’s implementation? How will Prevent Brazil try to improve policy feedback and engagement of municipal and frontline health workers in the policymaking process? Considering that the new payment for performance evaluation is supposed to take place and change every four months, what are the strategies planned to monitor the implementation and provide realistic evidences for change?  How is Brazil planning to disseminate the logics and knowledge regarding payment for performance to municipalities and front liners? Will evaluation be based only on quantitative indicators, or are there any plans to follow the implementation process and effectively engage front liners? How is Brazil willing to learn from the English case by including qualitative indicators to improve primary care?

It is expected that this seminar will shed lights on how Brazil could promote future analyses and changes in its new programme, at the policymaking, implementation and research realms.





SESSION 1: Development and challenges regarding the Quality Outcomes Framework

  • Chair: Stephen Peckham (University of Kent, UK)
  • Rachel Foskett-Tharby, National Health System, England. Challenges regarding the development of QOF in England
  • Lindsay Forbes, University of Kent. Evidence on the QOF
  • Prof. Martin Roland, University of Cambridge, Success and failures of QOF - lessons for LMICs and Brazil
  • Discussants: Verna Smith (Victoria University of Wellington, N. Zealand), Prof. Tim Doran (University of York).


14:20h - 14:40h – Coffee Break


SESSION 2: Payment for Performance and primary health care in Brazil: lessons and challenges (PMAQ and the new Brazil Prevent programme)

  • Chair: Gerald Bloom, Institute of Development Studies, IDS
  • Larissa Gabrielle Ramos, Secretariat of Primary Health Care, Brazilian Ministry of Health - The new Brazilian p4p scheme (Prevent Brazil): How are Brazilian policymakers learning from the British QOF?
  • Tim Powell-Jackson, London School of Hygiene and Tropical Medicine (LSHTM), UK; EQUI-PMAQ project: An analysis about the Brazilian PMAQ: and lessons for Brazil`s new payment for performance programme
  • Fabiana C. Saddi. UFG and University of Kent, British Academy Newton Advanced Fellow. The implementation of PMAQ and QOF – extracting political lessons for the new Brazilian p4p scheme (Prevent Brazil)
  • Discussants: Garret Brown, University of Leeds and Prof. Stephen Peckham, University of Kent, Dr. Loveday Penn-Kekana, LSHTM.


FINAL REMARKS – How can Brazil learn from the English QOF? – Comparative analyses and lessons from the QOF and PMAQ

  • Chair Fabiana C. Saddi,
  • Stephen Peckham, University of Kent
  • Josephine Borghi, LSHTM, EQUI-PMAQ project.
  • Gerald Bloom, IDS
  • Larissa Gabrielle Ramos, MoH, Brazil



Support: This seminar is supported by the How to strengthen leadership and the workforce through the re-design and implementation of a pay for performance program (PMAQ) in PHC in Brazil. A comparative health policy and system analysis British Academy Newton Advanced Fellowship project, funded by the British Academy and Newton Fund.


Organizers: Dr. Fabiana C. Saddi ( , ) Faculty of Social Sciences, Federal University of Goias (Brazil) and Centre for Health Services Studies, University of Kent (UK); Dr. Lindsay Forbes ( ) and Prof. Stephen Peckham ( ), Centre for Health Services Studies, University of Kent (UK).


Support team - Joao Paulo Marra Dantas, Mariana de Andrade Silva, Renata Batista Lozano (Researchers at the British Academy/NF project UFG/Brazil) and CHSS/University of Kent administrative staff. Translation of Brazilian documents in English: Maria Barretos (Master researcher in Political Science/UFG, Brazil)


REGISTRATION NEEDED - Entrance free. Capacity: 26 attendees and 14 participants/collaborators. Make your registration to guarantee your place. Registration needed at


London Seminar P4P BANNER