Pay-for-Performance Debate: Not Seeing the Forest for the Trees

Soucat, Agnès; Dale, Elina; Mathauer, Inke; Kutzin, Joseph

doi:10.1080/23288604.2017.1302902

Cited by 52 publications

(45 citation statements)

References 19 publications

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“…Finally, it is important to note that the framework has been developed to analyse 'strategic purchasing' mechanisms in general and not specifically RBF or the effects of RBF on purchasing arrangements. Indeed, as elaborated below, RBF remains one of the mechanisms among others, and does not necessarily aim to cover all the actions and decisions of strategic purchasingthough arguably it should be aligned and integrated with the existing purchasing architecture 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the limitations, this article adds to the limited literature on RBF in low and middle income countries and how it affects and makes more 'strategic' the existing purchasing arrangements. Based on our case study of Zimbabwe, it suggests that expectations of institutional reform and in particular the potential for RBF to drive a more strategic approach to purchasing [5] [4] should be moderated, particularly at early stages of RBF implementation [43] . Considering our strategic purchasing framework, we find (see summary in Table 3) that rather than systematically reforming strategic purchasing functions, in contexts like Zimbabwe's RBF adds a new provider payment mechanism into the mix, which can produce benefits, but also adds to a complex landscape and does not resolve many underlying challenges [44] [45] iv .…”

Section: Discussionmentioning

confidence: 99%

“…While research and evidence on RBF has grown since the first systematic review of its application in low and middle income countries [2], there remain some very significant gaps in our understanding of it, in particular in FCAS, where there is a need to understand the programmes' proliferation and how they may operate differently in these contexts [3], but also to examine their integration and wider system effects. RBF has been presented by some authors as a health system intervention with the potential to drive a more strategic approach to purchasing [4]. Others have suggested that it is likely that RBF could spur strategic purchasing reform during the 'expansion' phase when it becomes part of the system [5].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

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Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

Witter

Chirwa

Chandiwana

et al. 2020

BMC Health Serv Res

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Background: Results-Based Financing (RBF) has proliferated in the health sectors of low and middle income countries, especially those which are fragile or conflict-affected, and has been presented by some as a way of reforming and strengthening strategic purchasing. However, few if any studies have empirically and systematically examined how RBF impacts on health care purchasing. This article examines this question in the context of Zimbabwe's national RBF programme. Methods: The article is based on a documentary review, including 60 documents from 2008 to 2018, and 40 key informant (KI) interviews conducted with international, national and district level stakeholders in early 2018 in Zimbabwe. Interviews and analysis of both datasets followed an existing framework for strategic purchasing, adapted to reflect changes over. Results: We find that some functions, such as assessing service infrastructure gaps, are unaffected by RBF, while others, such as mobilising resources, are partially affected, as RBF has focused on one package of care (maternal and child health services) within the wider essential health care, and has contributed important but marginal costs. Overall purchasing arrangements remain fragmented. Limited improvements have been made to community engagement. The clearest changes to purchasing arrangements relate to providers, at least in relation to the RBF services. Its achievements included enabling flexible resources to reach primary providers, funding supervision and emphasising the importance of reporting.(Continued on next page)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: (Continued From Previous Page)mentioning

confidence: 99%

See 1 more Smart Citation

Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

Witter

Chirwa

Chandiwana

et al. 2020

BMC Health Serv Res

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“…5 While there is a growing recognition of the importance of the implementation context in determining PBF success in the literature and applied discourse, research is yet scarce. [6][7][8] In regards to health worker motivation, research points at rigid procurement channels and human resources shortages as demotivators in the context of PBF. 3,9,10 However, there are no studies explicitly investigating how the implementation context shapes health workers' motivational reactions to PBF yet.…”

Section: Introductionmentioning

confidence: 99%

Burkina Faso

2017

International Trade Statistics Yearbook (Ser. G)

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Background: Performance-based financing (PBF) is currently tested in many low-and middle-income countries as a health system strengthening strategy. One of the main mechanisms through which PBF is assumed to effect change is by motivating health workers to improve their service delivery performance. This article aims at a better understanding of such motivational effects of PBF. In particular, the study focused on organizational context factors and health workers' perceptions thereof as moderators of the motivational effects of PBF, which to date has been little explored. Methods: We conducted a multiple case study in 2 district hospitals and 16 primary health facilities across three districts. Health facilities were purposely sampled according to pre-PBF performance levels. Within sampled facilities, 82 clinical skilled healthcare workers were in-depth interviewed one year after the start of the PBF intervention. Data were analyzed using a blended deductive and inductive process, using self-determination theory (SDT) as an analytical framework. Results: Results show that the extent to which PBF contributed to positive, sustainable forms of motivation depended on the "ground upon which PBF fell, " beyond health workers' individual personalities and disposition. In particular, health workers described three aspects of the organizational context in which PBF was implemented: the extent to which existing hierarchies fostered as opposed to hindered participation and transparency; managers' handling of the increased performance feedback inherent in PBF; and facility's pre-PBF levels in regards to infrastructure, equipment, and human resources. Conclusion: Our results underline the importance of leadership styles and pre-implementation performance levels in shaping health workers' motivational reactions to PBF. Ancillary interventions aimed at fostering participatory as opposed to directional leadership or start-up support to low-performing health facilities will likely boost PBF effects in regards to the development of valuable motivational capacities.

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“…While the term results-based financing refers to demand- and supply-side incentives to increase output – that is, improved access to and quality of health care – this editorial focuses on the incentives that target service providers, also referred to as performance-based financing or pay-for-performance. Although the topic is well covered, 1 – 3 the literature tends to examine pay-for-performance in isolation from the health system, rather focusing on the efficacy of the intervention 4 . While useful, these studies provide insufficient guidance on how to scale up these interventions.…”

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confidence: 99%