Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider’s perspective in Rungwe Tanzania

Abstract

BackgroundIn recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers’ perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania.MethodsThis was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach.ResultsOverall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project.ConclusionDespite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted the potential of PBF to act as leverage for initiating innovative and proactive actions, which may motivate health personnel performance and quality of care in the study setting with minimal support. However, key policy issues at the national level should be addressed in order to exploit this opportunity.

Measuring three aspects of motivation among health workers at primary level health facilities in rural Tanzania

“…The results of our regression analysis demonstrated that job description was the key variable for health worker motivation in both Management and Performance Aspects. A job description is defined as “a document, on file, that states the job title, describes the responsibilities of the position, the direct supervisory relationships with other staff, and the skills and qualifications required for the position [ 46 ].” A number of studies have revealed a positive relationship between well-defined roles and responsibilities of health workers and their performance [ 1 , 11 , 22 , 47 , 48 ], and that health workers with a job description have greater confidence in their roles and responsibilities [ 27 ]. In our study, 39% of the participants claimed that they did not have a job description or that they did not know whether they had one.…”

Setting performance-based financing in the health sector agenda: a case study in Cameroon

“…Recent research suggest the positive impacts of PBF on health service utilization [ 3 – 6 ] and on the quality of care [ 15 , 16 ]. On the other hand, several theoretical and empirical studies have pointed out possible inconsistent and undesirable effects linked to the introduction of PBF in a complex system such as services distortion, gaming, inequity and dilution of intrinsic motivation [ 17 – 21 ].…”

Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo

“…The proposed model is mainly based on local elements, already existing at the local level in contrast with other social accountability mechanisms which use external actors for collecting community concerns and for exerting enforceability such as community score cards [ 37 , 38 ] and performance based financing [ 28 ] or that promote inappropriate tools such as suggestion box in a context of high illiteracy [ 39 ]. However, the implementation of few of its activities need financial resources such as providing financial incentives to CHWs, notebooks for CHWs or financial support/remuneration for supervision.…”

“…Findings of this study suggest to clearly insert in the missions of CHWs, the active collection and the transmission of community concerns [ 34 ]; and in the missions of HC, the interface role, the management of community concerns collected through CHWs and the organization of dialogue meetings. In terms of practices in the health system, the findings of this study suggest an improvement in the organization and the operation of community participation, and an improvement of its supervision by the health zone management team [ 34 , 46 , 47 ]. The study findings also raise some issues such as the motivation of CHWs and the central position of health providers in community participation [ 34 , 47 , 48 ],…”