When incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania - a qualitative study

Chimhutu, Victor; Lindkvist, Ida; Lange, Siri

doi:10.1186/1472-6963-14-23

Cited by 56 publications

(33 citation statements)

References 29 publications

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“…Among providers trained in LARC, several had never inserted an IUC. Insufficient expertise in method insertion due to inadequate training are well-established concerns for procedurally demanding contraceptive methods 23 . In El Salvador and Kenya, providers cited a cycle of infrequent insertion leading to low levels of self-confidence in ability 8,9 .…”

Section: Discussionmentioning

confidence: 99%

Family planning providers’ experiences and perceptions of long-acting reversible contraception in Lilongwe, Malawi

O’Shea¹,

Mwafulirwa²,

Hamela³

et al. 2014

Contraception

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Less than 2% of Malawian women use long-acting reversible contraception (LARC). We describe experiences of Malawian family planning providers, focusing on LARC. We conducted a mixed-methods study using questionnaires and focus group discussions with providers in Lilongwe. Data were analyzed separately and triangulated. Most (58%) participants saw over 30 patients daily. Only 19% had ever inserted IUC. Qualitative data were complementary; participants noted that LARC provision was important, though hindered by lack of experienced providers, work burden, and low demand. Future efforts to improve LARC access in Lilongwe must address both supply and demand-side barriers. (Afr J Reprod Health 2016; 20[2]: 62-71).Keywords: Family planning, long-acting reversible contraception, Malawi. RésuméMoins de 2% des femmes malawiennes utilisent la contraception de longue durée d'action réversible (CLDR). Nous décrivons les expériences des prestataires de planification familiale malawienne, en nous concentrant sur CLDR. Nous avons effectué une étude des méthodes mixtes à l'aide des questionnaires et des discussions de groupes cibles avec les fournisseurs à Lilongwe. Les données ont été analysées séparément et ont été triangulées. La plupart (58%) des participants ont vu plus de 30 patientes par jour. Seulement 19% avaient déjà inséré DIU. Les données qualitatives etaient complémentaires; les participants ont noté que la provision de la CLDR était importante, quoique entravée par le manque de fournisseurs expérimentés, la charge de travail, et la faible demande. Les futurs efforts pour améliorer l'accès à la CLDR à Lilongwe doit s'occuper des deux barrières de coté de l'offre et de la demande. (Afr J Reprod Health 2016; 20[2]: 62-71).Mots-clés: planification familiale, contraception de longue durée d'action réversible, Malawi.

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Section: Discussionmentioning

confidence: 99%

Family planning providers’ experiences and perceptions of long-acting reversible contraception in Lilongwe, Malawi

O’Shea¹,

Mwafulirwa²,

Hamela³

et al. 2014

Contraception

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“…3 Association Action Gouvernance Intégration Renforcement (AGIR), Ouagadougou, Burkina Faso. 4 IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, Paris, France. 5 University of Montreal Public Health Research Institute (IRSPUM), Montreal, QC, Canada.…”

Section: Ethical Issuesmentioning

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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“…For example, electronic methods used by local officials to monitor providers' attendance, such as through smartphones or other devices, have been shown to increase staff attendance Callen and others 2013;Dhaliwal and Hanna 2014). Attaching incentives to monitoring mechanisms, such as through performance-based pay schemes, bonuses, promotions, and official recognition by local governments, have proven to induce greater commitment and compliance with standards Chimhutu, Lindkvist, and Lange 2014; de Walque and others 2015; Gertler and Vermeersch 2013; Huillery and Seban 2014; Muralidharan and Sundararaman 2011).…”

Section: Top-down Accountabilitymentioning

confidence: 99%

The Last Mile to Quality Service Delivery in Jordan

Rabie¹,

Towfighian²,

Clark³

et al. 2017

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proximity to the actual service delivery exchange, within-facility accountability may be able to overcome some of the limitations of top-down and bottom-up mechanisms, substantially contributing to improved provider accountability. This book contributes to addressing this underemphasis, specifically focusing on the linkages between within-facility accountability and provider effort in the health and education sectors in Jordan. In the case of healthcare, a study was developed to generate novel insights from an original survey instrument. It is worth noting that this is the first nationally representative study in Jordan to measure within-facility accountability and provider effort in primary health care facilities, and the first study in the Middle East and North Africa region to investigate these linkages. The study relies on a nationally representative sample of 122 primary healthcare facilities where data are collected through patient exit interviews, and surveys administered to chief medical officers, doctors, and nurses who work at the centers, and where available, a representative of the community health committee. In the case of education, an empirical analysis of a nationally representative sample of 156 schools was conducted, relying on existing data collected through principal, teacher, and student surveys; third-party classroom observations and school inventories; and math and reading student assessments. This empirical analysis was complemented by a comparative case study of six Jordanian schools using statistical matching and a process-tracing procedure. Jordan provides an excellent case to study the role of Accountability in improving the Quality of education and Healthcare service Delivery In the past two decades, Jordan has achieved close to universal primary school enrollment (97 percent) and completion (93 percent), as well as high enrollment (88 percent) and completion (90 percent) rates at the secondary level, on par with Organisation for Economic CoOperation and Development (OECD) countries. Yet, international student assessments refocus the country's attention on what actually matters: student learning. Despite high levels of educational attainment, 15-year-old Jordanians' average mathematics, language, and science Program for International Student Assessment (PISA) scores rank among the lowest of PISA-participating countries. Similarly, in education systems that participate in the Trends in International Mathematics and Science (TIMSS) Study, eighth-grade students' average achievement in both mathematics and science ranks at nearly the bottom. Indicators as such are somewhat unexpected given Jordan's internationally comparable expenditure levels in the education sector. Public education expenditure as a share of total government expenditure stood at roughly 10.3 percent in 2012, slightly above the OECD average for that same year (9.8 percent), and on par with, for example, strong PISA performers such as Austria, Germany, and Poland. Furthermore, public education expenditure as a share of GD...

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When incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania - a qualitative study

Cited by 56 publications

References 29 publications

Family planning providers’ experiences and perceptions of long-acting reversible contraception in Lilongwe, Malawi

Family planning providers’ experiences and perceptions of long-acting reversible contraception in Lilongwe, Malawi

Burkina Faso

The Last Mile to Quality Service Delivery in Jordan

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