 That being said, there are some pitfalls of the pay for performance model that should be considered in the implementation phase of an HIV/AIDS-based bonus model in Namibia in order to be successful.
	Firstly, it is important that the performance measures that are rewarded are 1) based on research done on current levels of treatment/access and 2) targeted at increasing quality and care.  If targets are not set based on current levels of services provided, there is a chance that levels will be set too low and will not affect services provided.  This was seen when the UK established a pay for performance model in the 80s.  Not only did most doctors earn nearly the limit for bonuses offered (well over $100,000), but studies showed that the services provided were comparable to US rates, which did not have a bonus model.  In other words, the performance measures were set too low and were too easy to meet to have any real effect on care.  In addition, setting out-come based and quality-based targets must be the focus.  One concern with setting a target such as total number of HIV tests administered means that providers have incentives to test people already tested recently (within the last three months, say) or people who have no risk.  There is some incentive to abuse the system for providers, in other words.
	Another problem with a pay for performance model is the risk that it might cause some adverse selection.  If there are performance measures for the percentage of HIV-positive patients on ARVs, for instance, there would be an incentive for providers not to take on new HIV-positive clients to ensure they are still meeting these sorts of ratio benchmarks.  It is important to keep in mind these sorts of unintended consequences of pay for performance implementation.
	A third and final issue with the pay for performance model is the fact that it will increase administrative costs.  Rather than paying providers on a salaried basis, the setting of performance targets means there will need to be follow-up to ensure services provided are not inflated and there is a new built in payment system that requires more staff.  While this shouldn't discourage a country from implementing a pay for performance model, it must be considered early on, as healthcare spending will likely increase.  Ensuring that the benefits outweigh the expected cost increases is of the utmost importance.
	In establishing a pay for performance model, it is important that Namibia first ensure they have reliable data as to the current inefficiencies in their HIV/AIDS monitoring and treatment system, otherwise they risk setting performance targets that are too easy to meet, much like the UK did.  A thorough study of how frequently HIV testing and treatment is done must be performed before targets can be realistically set.
	The need for quality data is also an ongoing concern, as services provided will need to continue to be monitored once a bonus structure is put in place. 