Does the gap between health workers’ expectations and the realities of implementing a performance-based financing project in Mali create frustration?

Global Health Research and Policy

Valéry Ridde¹  Amandine Fillol²  Tony Zitti³  Julia Lohmann⁴  Abdourahmane Coulibaly⁵ 

[1]Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France

[2]Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France

[3]Ecole de santé publique de l’Université de Montréal, Montréal, Canada

[4]Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France

[5]École doctorale Pierre Louis de santé publique, Université de Paris, Paris, France

[6]ONG Miseli, Bamako, Mali

[7]London School of Hygiene & Tropical Medicine, London, UK

[8]Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany

[9]ONG Miseli, Bamako, Mali

[10]Faculté de Médicine et d’Odontostomatologie, Université des Sciences, des Techniques et des Technologies, Bamako, Mali

关键词: Motivation of health workers;    Performance-based financing;    District hospital;    expectations;    Frustration;    Mali;   

DOI  :  10.1186/s41256-021-00189-0

来源: Springer

【 摘 要 】

BackgroundPerformance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating health workers. The purpose of this research was to identify and understand how health workers’ expectations related to their experiences of the first cycle of payment of PBF subsidies, and how this experience affected their motivation and sentiments towards the intervention. We pose the research question, “how does the process of PBF subsidies impact the motivation of health workers in Mali?”MethodsWe adopted a qualitative approach using multiple case studies. We chose three district hospitals (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each DH. We analyzed data in a mixed deductive and inductive manner.ResultsThe results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work more efficiently. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention.ConclusionThe PBF implementation in Mali left health workers frustrated. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. This underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.

【 授权许可】

CC BY