Pay for performance: an analysis of the context of implementation in a pilot project in Tanzania

BMC Health Services Research

Josephine Borghi¹  Salim Abdulla²  Peter Binyaruka²  Edith Patouillard¹  Masuma Mamdani²  Ikunda Njau²  Irene Mashasi²  Iddy Mayumana²  Anna Elisabet Olafsdottir² 

[1] Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H NSH, UK;Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania

关键词: Low income countries;    Health workers motivation;    Contextual factors;    Health system;    Paying for performance;   

Others  :  1126429
DOI  :  10.1186/1472-6963-14-392

 received in 2013-12-20, accepted in 2014-09-15,  发布年份 2014

【 摘 要 】

Background

Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets.

Method

40 in-depth interviews and four focus group discussions were undertaken with health workers, and regional, district and facility managers. Data was collected on work environment characteristics and staff attitudes towards work in the first phase of the implementation of the pilot. A survey of 75 facilities and 101 health workers were carried out to examine facility resourcing, and health worker employment conditions and job satisfaction.

Results

Five contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment; supervision; facility access to utilities; and community preferences. The results suggest that it is important to consider contextual issues when implementing pay for performance schemes in low income settings. It highlights the importance of basic infrastructures being in place, a minimum number of staff with appropriate education and skills as well as sufficient resources before implementing pay for performance.

Conclusion

Health professionals working within a pay for performance scheme in Tanzania were concerned about challenges related to shortages of resources, limited supplies and unfavourable community preferences. The P4P scheme may provide the incentive and means to address certain constraints, in so far as they are within the control of providers and managers, however, other constraints will be harder to address.

【 授权许可】

   
2014 Olafsdottir et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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