Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe

Kadungure, Artwell; Brown, Garrett Wallace; Loewenson, René; Gwati, Gwati

doi:10.1108/jhom-06-2020-0215

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…Still, there are examples of facilities using payments to stimulate demand by improving structural quality (e.g. facility bonuses earmarked for general improvements or equipment) or providing free food for mothers to attract them to a facility (Kadungure et al. , 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, small incentives in LMIC contexts may represent a significant income improvement, explaining why smaller bonuses lead to improvements. In addition, staff in LMICs may be more reliant on bonuses for basic income “top-ups.” This difference to HICs highlights how contextual factors impact P4P design expectations and performance in different settings, and explains counter effects despite incentives in cases of high workloads, low staff numbers, inadequate training and/or lack of equipment (Kadungure et al. , 2021; Singh et al.…”

Section: Discussionmentioning

confidence: 99%

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Pay for performance at a crossroads: lessons from taking a global perspective

Kristensen,

Anselmi,

Brown

et al. 2023

IJPSM

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PurposeThe use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts.Design/methodology/approachThe authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries.FindingsThe quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting.Originality/valueThe research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pay for performance at a crossroads: lessons from taking a global perspective

Kristensen,

Anselmi,

Brown

et al. 2023

IJPSM

Self Cite

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“…Moreover, it explains why some global initiatives explicitly exclude demand-side interventions as part of their performance-based financing schemes, as is the case with the World Bank’s Global Financial Facility. 14 …”

Section: Financial Nudging and Incentivization Perpetuates The Paradigmmentioning

confidence: 99%

The Dynamics of Power Flow From the Global Health Financing Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process"

Brown

Rhodes

2023

Int J Health Policy Manag

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This article agrees with Lassa et al. that biomedical paradigms and medical professionals are a dominating force within the policy dynamics of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and that there needs to be greater community involvement in how global health initiatives (GHIs) are adopted, designed, implemented and evaluated. However, we argue that many of the conditions identified are entrenched and perpetuated by how GHIs are financed and the financing modalities employed in Development Aid for Health (DAH), particularly in low resource settings. As a result, the dynamics of power not only flow from traditionally entrenched epistemic authorities but are disproportionally sustained by global health financing modalities that favour particular GHIs over others. As we argue, these DAH modalities can exert forms of power with problematic effects on policy making.

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“…In schemes rewarding based on threshold targets, goal gradient theory suggests effort will increase as agents move closer to the goal, 10 and cease once the threshold is reached, 11 12 with multiple threshold targets being expected to encourage sustained effort. 13 Like many complex interventions, the design of P4P programmes is not static, and adaptations are commonplace during implementation, 14 and can result in changing effects over time. Further, actor response to incentives may not be constant.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

et al. 2021

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BackgroundThe success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.MethodsWe conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.ResultsProgramme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.ConclusionOur study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.

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Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe

Cited by 7 publications

References 31 publications

Pay for performance at a crossroads: lessons from taking a global perspective

Pay for performance at a crossroads: lessons from taking a global perspective

The Dynamics of Power Flow From the Global Health Financing Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process"

Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

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