Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach.
Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach.
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DOI：
10.1016/j.socscimed.2021.114277
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Borghi J
中科院分区：
文献类型：
--
作者：
Cassidy R;Tomoaia-Cotisel A;Semwanga AR;Binyaruka P;Chalabi Z;Blanchet K;Singh NS;Maiba J;Borghi J
低收入和中等收入国家采用了按业绩付费的做法，以提高妇幼保健服务的质量和覆盖面。然而，对于采购换采购如何影响卫生系统，缺乏共识。有必要使用适用于评估复杂系统的方法，评估采购促进步对卫生系统的影响。我们开发了一个因果循环图（CLD），以进一步了解P4P对坦桑尼亚妇幼保健服务提供和吸收的影响。CLD是利用坦桑尼亚P4P计划过程评价的定性数据开发和验证的，并通过额外的利益攸关方对话加强对图表的信心。CLD绘制了参与提供者实现目标，报告健康信息和人口就医的相互作用机制，并确定了受P4P影响的机制。例如，药品和医疗商品的供应不仅影响供应商实现P4P目标，而且影响服务需求，并通过额外设施资源的可用性和地区管理人员减少药品缺货的激励措施受到P4P的影响。地方发展中心还确定了设施实现目标的关键机制，但这些机制不在方案范围内;例如，保健设施管理委员会和社区保健工作者的活动是设施一级刺激需求和有效利用资源的关键，但这两类人都被排除在奖励制度之外。从这项工作中产生的采购促进步设计考虑因素包括适当激励药物的供应和设施中的工作人员以及那些负责在社区创造需求的人。迫切需要进一步研究使用CLD来研究LMIC的卫生系统，以进一步了解系统如何响应干预措施以及如何加强系统以提供更好的覆盖面和护理质量。整体分析是避免P4P性能欠佳的关键。药物的可用性受P4P的影响，并影响P4P的成功。需要激励设施外的团体支持服务范围。
Payment for performance (P4P) has been employed in low and middle-income (LMIC) countries to improve quality and coverage of maternal and child health (MCH) services. However, there is a lack of consensus on how P4P affects health systems. There is a need to evaluate P4P effects on health systems using methods suitable for evaluating complex systems. We developed a causal loop diagram (CLD) to further understand the pathways to impact of P4P on delivery and uptake of MCH services in Tanzania. The CLD was developed and validated using qualitative data from a process evaluation of a P4P scheme in Tanzania, with additional stakeholder dialogue sought to strengthen confidence in the diagram. The CLD maps the interacting mechanisms involved in provider achievement of targets, reporting of health information, and population care seeking, and identifies those mechanisms affected by P4P. For example, the availability of drugs and medical commodities impacts not only provider achievement of P4P targets but also demand of services and is impacted by P4P through the availability of additional facility resources and the incentivisation of district managers to reduce drug stock outs. The CLD also identifies mechanisms key to facility achievement of targets but are not within the scope of the programme; the activities of health facility governing committees and community health workers, for example, are key to demand stimulation and effective resource use at the facility level but both groups were omitted from the incentive system. P4P design considerations generated from this work include appropriately incentivising the availability of drugs and staffing in facilities and those responsible for demand creation in communities. Further research using CLDs to study heath systems in LMIC is urgently needed to further our understanding of how systems respond to interventions and how to strengthen systems to deliver better coverage and quality of care. Holistic analysis key to avoiding suboptimal P4P performance. Availability of drugs is influenced by P4P and affects success of P4P. Need to incentivise groups outside facility that support service coverage.
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发表时间：
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期刊：
Implementation science : IS
影响因子：
--
作者：
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