Local stakeholders' perceptions about the introduction of performance-based financing in Benin: a case study in two health districts
Local stakeholders' perceptions about the introduction of performance-based financing in Benin: a case study in two health districts
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DOI：
10.15171/ijhpm.2014.93
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发表时间：
2014-09-01
影响因子：
3.5
通讯作者：
Eclou, Dieudonne Sedjro
中科院分区：
文献类型：
--
作者：
Paul, Elisabeth;Sossouhounto, Nadine;Eclou, Dieudonne Sedjro
背景：以绩效为基础的筹资(PBF)已被作为一种解决方案提出，以促进改善发展中国家卫生系统的绩效。贝宁就是这种情况。本研究旨在通过调查当地利益相关者如何看待引入PBF的情况、在实施过程中如何适应不同的方法以及PBF引发的行为互动，来分析在贝宁试行的两种PBF方法在实施过程中的表现及其产生的影响。该设计是在故意选择的两个卫生区进行的个案研究。卫生设施的选择也是有目的的，直到我们达到信息饱和。通过观察法和半直接访谈法收集信息，并辅以访谈指南。数据通过内容和话语分析进行分析。结果：卫生部大力支持PBF，但与其他正在进行的改革和进程没有很好地结合。现场参与者欢迎PBF，但仍然没有主人翁意识。对于负责核查的机构而言，这两种建设和平基金的做法明显不同。绩效奖励是根据有限数量的量化指标加上一个广泛的定性清单发放的。PBF矩阵和核查任务是对常规监测的补充。当地利益攸关方接受理论方法。在全球范围内，工作人员对PBF感到满意，并欢迎更多的监督和培训。医疗服务提供者认为，PBF迫使他们背离常规，变得更专业，并尊重国家规范。一个主要问题是在保费分配方面存在明显的不公平。即使卫生工作人员经常提到财务保费，实际上后者可能太弱了--而且太模糊了--不能产生持久的刺激效应。相反，PBF似乎通过其“一揽子计划”的其他要素，特别是形成性监督来激励卫生工作者。结论：如果全球形势相当积极，几个问题可能会危及PBF的成功。似乎至关重要的是要减少系统中被认为不公平的情况，特别是要加强所有设施的能力，以确保它们符合国家规范，并确保系统的财政和体制可持续性。
Background: Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF.Methods: The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis.Results: The Ministry of Health (MoH) strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak-and 'blurred'-to have a lasting inciting effect. It rather seems that PBF motivates health workers through other elements of its 'package', especially formative supervisions.Conclusion: If the global picture is quite positive, several issues could jeopardise the success of PBF. It appears crucial to reduce the perceived unfairness in the system, notably through enhancing all facilities' capacities to ensure they are in line with national norms, as well as to ensure financial and institutional sustainability of the system.