A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda.
A process evaluation of performance-based incentives for village health workers in Kisoro district, Uganda.
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DOI：
10.1186/1478-4491-12-19
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发表时间：
2014-04-08
影响因子：
4.5
通讯作者：
Paccione GA
中科院分区：
文献类型：
--
作者：
Miller JS;Musominali S;Baganizi M;Paccione GA
为乡村卫生工作者（VHWs）设计有效的激励制度是一个长期的政策问题，对VHWs计划的成功和可持续性有重大影响。使用基于性能的激励（PBI）的VHWs是一种方法，已被提出并在一些程序中实施，但没有得到足够的审查和评价，在同行评审的文献。我们进行了一项过程评估，审查了乌干达基索罗的VHW使用所涉方案预算问题。在这一制度中，根据20项指标向保健工作者支付报酬，这些指标分为例行随访、健康教育活动、新病人识别、卫生设施覆盖率和优先保健服务的利用率。对VHW（n = 30）和项目主管（n = 7）进行调查，以评估可接受性和可行性。访谈进行了所有8个项目主管和6个有目的地选择的VHW，以获得更深入的了解他们对PBI系统的看法。计划预算记录被用来评估计划的成本。详细的支付记录被用来评估PBI系统在VHWs的性别，教育水平和村庄位置方面的公平性。在调查和访谈中，主管对PBI系统表示高度满意，尽管一些主管对VHW之间的薪酬差异和努力奖励的不确定性可能产生的负面影响表示担忧。VHWs认为该系统总体上是公平的，并且比以前的支付系统更喜欢它，但表示希望获得更多的报酬。每个VHW的年度方案费用为516美元，每个VHW平均覆盖115个家庭。覆盖更多家庭的家庭保健工作者往往赚得更多。有一些证据表明，女性与较高的收入有关。教育水平和邻近地区医院似乎没有与收入下的PBI系统。在一个小型VHW计划中进行的为期一年的PBI试点中，VHW和主管都发现PBI系统是可以接受的，并且具有激励作用。正规教育相对有限的VHW能够掌握PBI系统。需要进一步的研究来确定PBI的长期影响和可扩展性，以及在不同背景下的影响。
Designing effective incentive systems for village health workers (VHWs) represents a longstanding policy issue with substantial impact on the success and sustainability of VHW programs. Using performance-based incentives (PBI) for VHWs is an approach that has been proposed and implemented in some programs, but has not received adequate review and evaluation in the peer-reviewed literature. We conducted a process evaluation examining the use of PBI for VHWs in Kisoro, Uganda. In this system, VHWs are paid based on 20 indicators, divided among routine follow-up visits, health education activities, new patient identifications, sanitation coverage, and uptake of priority health services. Surveys of VHWs (n = 30) and program supervisors (n = 7) were conducted to assess acceptability and feasibility. Interviews were conducted with all 8 program supervisors and with 6 purposively selected VHWs to gain a deeper understanding of their views on the PBI system. Program budget records were used to assess the costs of the program. Detailed payment records were used to assess the fairness of the PBI system with respect to VHWs’ gender, education level, and village location. In surveys and interviews, supervisors expressed high satisfaction with the PBI system, though some supervisors expressed concerns about possible negative effects from the variation in payments between VHWs and the uncertainty of reward for effort. VHWs perceived the system as generally fair, and preferred it to the previous payment system, but expressed a desire to be paid more. The annual program cost was $516 per VHW, with each VHW covering an average of 115 households. VHWs covering more households tended to earn more. There was some evidence that female gender was associated with higher earnings. Education level and proximity to the district hospital did not appear to be associated with earnings under the PBI system. In a one-year pilot of PBI within a small VHW program, both VHWs and supervisors found the PBI system acceptable and motivating. VHWs with relatively limited formal education were able to master the PBI system. Further research is needed to determine the long-term effects and scalability of PBI, as well as the effects across varied contexts.
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影响因子：
3.2
作者：
Schneider, Helen;Hlophe, Hlengiwe;van Rensburg, Dingie
通讯作者：
van Rensburg, Dingie
影响因子：
4.2
作者：
Ramirez-Valles, J
通讯作者：
Ramirez-Valles, J
影响因子：
5.4
作者：
Glenton, Claire;Scheel, Inger B.;Shrestha, Vijaya
通讯作者：
Shrestha, Vijaya
影响因子：
5.4
作者：
BENDER, DE;PITKIN, K
通讯作者：
PITKIN, K
影响因子：
11.1
作者：
Ireland, Megan;Paul, Elisabeth;Dujardin, Bruno
通讯作者：
Dujardin, Bruno