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

Borghi, Josephine; Binyaruka, Peter; Mayumana, Iddy; Lange, Siri; Somville, Vincent; Mæstad, Ottar

doi:10.1136/bmjgh-2021-006409

Cited by 5 publications

(5 citation statements)

References 43 publications

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Section: Discussionmentioning

confidence: 99%

“…These studies have contributed to the realisation that P4P was not always effective in the longer term. However, studies emerging from LMICs have also looked at longer-term effects, finding evidence of attenuation of effects over time (Borghi et al, 2021;Falisse et al, 2015), as well as improvements (Rajkotia et al, 2017). More such studies are needed to aid our understanding of the temporal dynamics of P4P.…”

Section: Pay For Performance At a Crossroadsmentioning

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: Pay For Performance At a Crossroadsmentioning

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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“…Emphasis was made on the primary health level as the main point of entry for service provision and implementation of programs [ 9 ]. The devolution led to the introduction of the DHFF program to improve the allocative efficiency of funds and expenditure to be shaped by user preference [ 10 ]. The D by D enables the government to grant autonomy to healthcare facilities in the planning, fund management, procurement, and expenditure reporting of financial use and management [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of direct health facility financing in the Rural District of Kigoma in Western Tanzania

Joram,

Hiliza,

Nathanael

et al. 2023

Pan Afr Med J

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The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 key informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research.

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“…In Tanzania, PBF (in the name of pay for performance -P4P) intervention was introduced in Pwani Region in 2011 [8,9]. Its imple-mentation was shown to be influenced by the following "contextual factors": salary and employment benefits; resource availability including staff, medicines and functioning equipment; supervision; facility access to utilities; and community preferences [10].…”

Section: Introductionmentioning

confidence: 99%

“…Fifth, it was found to have potential for influencing efficiency in particular in public facilities but it requires further improvement in its design for this to be realized [15]. Sixth, it produced some sustained improvements in user (patient) experience of care such as kindness [9]. Seventh, it showed potential for reducing women bypassing a nearby health facility [16].…”

Section: Introductionmentioning

confidence: 99%

Contribution of Results-Based Financing in Quality Improvement of Health Services at Primary Healthcare Facilities: Findings from Tanzania Star Rating Assessment

2023

IJHPP

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Background: Performance-based financing (PBF) is an important mechanism for improving the quality of health services in low- and middle- income countries. In 2014, Tanzania launched a countrywide quality approach known as Star Rating Assessment (SRA) which aims to assess the quality of healthcare service delivery in all Primary Health Care (PHC) Facilities in the country. Furthermore, by 2018 (2015-2018), the country rolled out RBF initiatives into eight regions in which PHC facilities were paid incentives based on their level of achievement in SRA assessments. This study aims to compare performance in quality between PHC facilities under RBF regions and non-RBF regions using the findings from the twophases SRA assessments; baseline (2015/16) and follow-up (2017/18). Methods: Analysis of performance of SRA indicators in the SRA service areas were identified based on the star rating tool that was used. The star rating tool had 12 service areas. For the sake of this implementation study, only seven service areas were included. The purposive sampling of the areas was used to select the areas that had direct influence of RBF in health facilities improvement. We used a t-test to determine whether there were differences in assessment star rating scores between the regions that implemented RBF and those, which did not at each assessment (both baseline and reassessment). All results were considered significant at p<0.05. The 95% Confidence Interval was also reported. Results: The mean value was found to be 61.26 among facilities exposed to RBF compared to 51.28 among those not exposed to RBF. The study showed the mean difference score to be 10.79, with a confidence interval at 95% to be -1.24 to 22.84, suggesting that there was (no) a significant difference in the facilities based on RBF exposure during baseline assessment. The p-value of 0.07 was not statistically significant. Overall, there was an increment in facilities scoring the recommended 3+stars and above by 17.39% between the assessments, the difference was significant (p=0.0001). When the regions were stratified based on RBF intervention; facilities under RBF improved in 3+ stars by 10.63% higher compared to those that were not under RBF; however, the difference was not statistically significant (p=0.06) Conclusion: Improvement of Health services needs to adhere to all six WHO building blocks and not to a sole financing. The six WHO building blocks are 1. Service delivery 2. Health workforce 3. Health information systems 4. Access to essential medicines 5. Financing 6. Leadership/governance. Probably, RBF found not to influence star rating because other blocks were not considered in this intervention. We need to integrate all the six WHO building blocks whenever we want to improve health services provision.

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

Cited by 5 publications

References 43 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

Implementation of direct health facility financing in the Rural District of Kigoma in Western Tanzania

Contribution of Results-Based Financing in Quality Improvement of Health Services at Primary Healthcare Facilities: Findings from Tanzania Star Rating Assessment

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