Protocol for the evaluation of a pay for performance programme in Pwani region in Tanzania: A controlled before and after study
Protocol for the evaluation of a pay for performance programme in Pwani region in Tanzania: A controlled before and after study
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DOI：
10.1186/1748-5908-8-80
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发表时间：
2013-07-19
影响因子：
7.2
通讯作者：
Mamdani, Masuma
中科院分区：
文献类型：
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作者：
Borghi, Josephine;Mayumana, Iddy;Mamdani, Masuma
背景：利用供给方激励措施来提高卫生服务利用率和提高服务质量在许多低收入和中等收入国家正在蓬勃发展。然而，关于此类计划的影响、其成本效益、实施过程以及在这些情况下潜在的意外后果的证据很少。坦桑尼亚普瓦尼地区于 2011 年推出了绩效工资 (P4P) 计划。方法/设计：将对计划进行评估，为可能在全国范围内推广提供信息。一项前后对照研究将检验 P4P 计划对坦桑尼亚设施内有针对性的孕产妇和新生儿医疗保健服务以及选定的非针对性服务的质量、覆盖范围和成本的影响。数据将从对所有七个干预区的 75 个设施、750 名退出咨询的患者、超过 75 名卫生工作者以及 1,500 个上一年分娩妇女家庭的调查中收集。数据将从四个控制区的相同数量的受访者中收集。过程评估将检查： P4P 计划是否按计划实施；利益相关者对计划的反应及其可接受性；以及实施瓶颈和促进因素。将进行三轮过程数据收集，包括对现有 P4P 文件的审查、个人访谈以及与在五个干预区的设施和地区一级以及地区和国家一级工作的主要知情人进行焦点小组讨论。经济评估将从社会角度衡量 P4P 相对于当前实践的成本效益。讨论：该评估将为低收入环境中 P4P 的影响和成本效益提供强有力的证据，并更好地了解将 P4P 等复杂干预方案整合到资源匮乏环境中的卫生系统中的可行性。
Background: The use of supply-side incentives to increase health service utilisation and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is a paucity of evidence on the impact of such schemes, their cost-effectiveness, and the process of implementation and potential unintended consequences in these settings. A pay for performance (P4P) programme was introduced in Pwani region of Tanzania in 2011.Methods/design: An evaluation of the programme will be carried out to inform a potential national rollout. A controlled before and after study will examine the effect of the P4P programme on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. Data will be collected from a survey of 75 facilities, 750 patients exiting consultations, over 75 health workers, and 1,500 households of women who delivered in the previous year, in all seven intervention districts. Data will be collected from the same number of respondents in four control districts. A process evaluation will examine: whether the P4P programme was implemented as planned; stakeholder response to the programme and its acceptability; and implementation bottlenecks and facilitating factors. Three rounds of process data collection will be conducted including a review of available P4P documents, individual interviews and focus group discussions with key informants working at facility and district level in five of the intervention districts, and at the regional and national levels. An economic evaluation will measure the cost-effectiveness of P4P relative to current practice from a societal perspective.Discussion: This evaluation will contribute robust evidence on the impact and cost-effectiveness of P4P in a low income setting, as well as generate a better understanding of the feasibility of integrating complex intervention packages like P4P within health systems in resource poor settings.