Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe.
Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe.
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DOI：
10.1093/heapol/czab154
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发表时间：
2022-04-13
影响因子：
3.2
通讯作者：
Borghi, Josephine
中科院分区：
文献类型：
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作者：
Kovacs, Roxanne;Brown, Garrett W.;Kadungure, Artwell;Kristensen, Soren R.;Gwati, Gwati;Anselmi, Laura;Midzi, Nicholas;Borghi, Josephine
虽然按业绩计薪（P4P）计划已在低收入和中等收入国家（LMIC）实施，但对其分配后果知之甚少。一个关键的问题是，财务奖金主要由那些已经能够更好地执行的提供者（例如，那些在较富裕地区的提供者）获得，P4P可能会加剧卫生系统内现有的不平等。我们研究了津巴布韦国家P4P计划（2014-2016）中奖金分配的不平等性，使用了奖金支付和设施特征的定量数据以及专题政策审查和28个半结构化访谈的结果。我们发现，在津巴布韦，有更好的基线访问指南，更多的工作人员，更高的咨询量和更富裕和更少的偏远目标人群的设施在整个计划中获得了显着更高的P4P奖金。例如，在获得指南方面高于平均值1 SD的设施，每季度比低于平均值1 SD的设施多赚90美元。在员工数量和咨询量方面高于和低于平均值1 SD的设施的奖金支出差异甚至更明显，每季度为348美元和445美元。同样，在其附近最贫穷的五分之一村庄的设施比所有其他设施的收入都要少，并且每季度比为最富有的五分之一村庄服务的设施少752美元。定性数据证实了这些发现。受访者确定设施基线结构质量，领导，集水人口规模和偏远影响性能的计划。P4P支出分配不平等被认为对员工保留、缺勤和积极性产生了负面影响。根据我们的研究结果和以前的工作，我们提供了一些指导政策制定者如何设计更公平的P4P计划。
Although pay-for-performance (P4P) schemes have been implemented across low- and middle-income countries (LMICs), little is known about their distributional consequences. A key concern is that financial bonuses are primarily captured by providers who are already better able to perform (for example, those in wealthier areas), P4P could exacerbate existing inequalities within the health system. We examine inequalities in the distribution of pay-outs in Zimbabwe’s national P4P scheme (2014–2016) using quantitative data on bonus payments and facility characteristics and findings from a thematic policy review and 28 semi-structured interviews with stakeholders at all system levels. We found that in Zimbabwe, facilities with better baseline access to guidelines, more staff, higher consultation volumes and wealthier and less remote target populations earned significantly higher P4P bonuses throughout the programme. For instance, facilities that were 1 SD above the mean in terms of access to guidelines, earned 90 USD more per quarter than those that were 1 SD below the mean. Differences in bonus pay-outs for facilities that were 1 SD above and below the mean in terms of the number of staff and consultation volumes are even more pronounced at 348 USD and 445 USD per quarter. Similarly, facilities with villages in the poorest wealth quintile in their vicinity earned less than all others—and 752 USD less per quarter than those serving villages in the richest quintile. Qualitative data confirm these findings. Respondents identified facility baseline structural quality, leadership, catchment population size and remoteness as affecting performance in the scheme. Unequal distribution of P4P pay-outs was identified as having negative consequences on staff retention, absenteeism and motivation. Based on our findings and previous work, we provide some guidance to policymakers on how to design more equitable P4P schemes.
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DOI：
10.1016/s2214-109x(20)30480-0
发表时间：
2021-03
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kovacs R;Maia Barreto JO;da Silva EN;Borghi J;Kristensen SR;Costa DRT;Bezerra Gomes L;Gurgel GD Junior;Sampaio J;Powell-Jackson T
通讯作者：
Powell-Jackson T
影响因子：
3.2
作者：
Kuunibe, Naasegnibe;Lohmann, Julia;De Allegri, Manuela
通讯作者：
De Allegri, Manuela
影响因子：
2.8
作者：
Antony, Matthieu;Bertone, Maria Paola;Barthes, Olivier
通讯作者：
Barthes, Olivier
影响因子：
3
作者：
Horwitz, Leora, I;Wang, Yongfei;Herrin, Jeph
通讯作者：
Herrin, Jeph
影响因子：
8.1
作者：
Binyaruka, Peter;Anselmi, Laura
通讯作者：
Anselmi, Laura