Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania

Abstract

BackgroundHealth workers’ motivation is a key determinant of the quality of health services, and poor motivation has been found to be an obstacle to service delivery in many low-income countries. In order to increase the quality of service delivery in the public sector in Tanzania, the Open Performance Review and Appraisal System (OPRAS) has been implemented, and a new results-based payment system, Payment for performance (P4P) is introduced in the health sector. This article addresses health workers’ experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health workers’ motivation in low-income contexts.MethodsA qualitative study design has been employed to elicit data on health worker motivation at a general level and in relation to OPRAS and P4P in particular. Focus group discussions (FGDs) and in-depth interviews (IDIs) have been conducted with nursing staff, clinicians and administrators in the public health sector in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania.ResultsHealth workers evaluated OPRAS and P4P in terms of the benefits experienced or expected from complying with the tools. The study found a general reluctance towards OPRAS as health workers did not see OPRAS as leading to financial gains nor did it provide feedback on performance. Great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear.ConclusionsHealth workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits. The importance placed on salary and allowances forms the setting in which OPRAS operates. The expected addition to the salary through P4P has created a vigorous discourse among health workers attesting to the importance of the salary for motivation. Lessons learned from OPRAS can be utilized in the implementation of P4P and can enhance our knowledge on motivation and performance in the health services in low-income contexts such as Tanzania.

Strengthening Strategic Reward Framework in Health Systems: A Survey of Narok County, Kenya

“…In addition, implementation of monetary and non-monetary incentives for HWs working in rural and remote areas had been seriously neglected by the government, even though experiments with such schemes, including deprived area allowances and car incentives, had been conducted (Bonenberger et al, 2014). Similar findings were also reported in Tanzania where HWs claimed that they do not receive regular feedback on the work they perform and held this out as a serious shortcoming of the workplace management (Songstad et al, 2012). In this study, Narok County scores low in providing incentives to its health workforce.…”

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“…This confirms with the study by Songstad et al (2012) who advised that an employee performance appraisal should serves as a means for management to evaluate and provide feedback on employee job performance, including steps to improve on their deficiencies as needed.…”

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

“…Across these studies, most schemes provided monthly payments, as was the case for instance in a scheme in China [44]. However, some schemes paid bonuses only once a yearsuch as the Open Performance Review and Appraisal System in Tanzania [50].…”