Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria.
Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria.
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DOI：
10.1093/heapol/czx146
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发表时间：
2018-01-01
影响因子：
3.2
通讯作者：
Bennett SC
中科院分区：
文献类型：
--
作者：
Mabuchi S;Sesan T;Bennett SC
发展中国家初级卫生设施绩效的决定因素尚未得到充分研究。研究最少的领域之一是卫生设施管理。本研究调查了尼日利亚试点绩效融资（PBF）计划下的卫生设施，旨在了解哪些因素区分了表现良好的初级卫生保健中心（PHCC），与那些没有，重点是卫生设施管理实践。我们使用了多个案例研究，其中我们比较了两个高性能PHCC和两个低性能PHCC的两个PBF目标状态。由两名受过培训的当地研究人员组成的两个小组在每个PHCC呆了一周，收集了半结构化的访谈、观察和文件数据。访谈数据采用框架方法进行转录、翻译和编码。对每个PHCC的数据进行合成，以了解每种情况下不同元素的动态相互作用。然后，我们比较了高绩效者和低绩效者的特征。表现优异和表现不佳的组织之间出现重大差异的领域是：社区参与和支持;以及业绩和工作人员管理。我们还发现，（一）背景和卫生系统因素，特别是人员配备，访问和与其他供应商的竞争;（二）卫生中心管理，包括社区参与，绩效管理和员工管理;（三）社区领导人的支持互动，推动PHCC之间的绩效改善。其中，我们发现，良好的卫生中心管理可以克服一些背景和卫生系统的障碍，并加强社区领导人的支持。这项研究结果表明，强烈需要选择有能力和积极主动的健康中心管理人员，提供长期的教练管理技能，并激励他们改善他们的做法。该研究还强调，有必要将与社区领导人的接触定位为一项关键的管理实践和干预措施的核心要素，以提高PHCC的绩效。
The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centres (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health centre management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health centre management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health centre managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance.
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影响因子：
1.2
作者：
McCarthy, Geraldine;Fitzpatrick, Joyce J.
通讯作者：
Fitzpatrick, Joyce J.
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通讯作者：
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通讯作者：
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