Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone
Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone
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DOI：
10.1186/s12913-016-1546-8
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发表时间：
2016-07-19
影响因子：
2.8
通讯作者：
Witter, Sophie
中科院分区：
文献类型：
--
作者：
Bertone, Maria Paola;Lagarde, Mylene;Witter, Sophie
背景：基于绩效的融资（PBF）对卫生工作者的动机和绩效的影响越来越受到关注。然而，迄今为止的文献往往孤立地看待建设和平基金的付款，而没有提及保健工作者的总体薪酬。以塞拉利昂为例，在2011年引入PBF，本研究调查了PBF对卫生工作者收入的绝对和相对贡献，并探讨了他们对PBF奖金的看法，与其他收入进行比较和互动。方法：该研究基于一项混合方法研究，包括一项调查和一份为期8周的纵向日志，收集初级卫生工作者的收入数据（n = 266）和39个深度访谈的子样本相同的工人，在塞拉利昂的三个地区（博城，凯内马和莫扬巴）进行。结果：我们的研究结果表明，在这种情况下PBF贡献约10%的卫生工作者的总收入。尽管贡献相对较低，但他们对奖金的看法是积极的，特别是与对工资的负面看法相比。我们发现，这是因为PBF被视为一种补充，与正式工资相比，其权利感较低。此外，建设和平基金在卫生工作者制定的收入使用战略中发挥着特殊作用，因为它提供额外资金，可用于紧急情况或再投资于创收活动。然而，建设和平基金计划的执行问题，如延迟支付和难以获得，造成了一系列问题，限制了奖励措施的激励作用。总体而言，工作人员仍然倾向于增加工资在PBF.Conclusions的增加：研究证实，卫生工作者的薪酬是复杂的，相互关联的，使不同的经济激励不能独立地检查。它还表明，PBF计划的实施影响到它是否激励卫生工作者，必须进行彻底的研究，以评估PBF的影响。
Background: There is growing interest on the impact of performance-based financing (PBF) on health workers' motivation and performance. However, the literature so far tends to look at PBF payments in isolation, without reference to the overall remuneration of health workers. Taking the case of Sierra Leone, where PBF was introduced in 2011, this study investigates the absolute and relative contribution of PBF to health workers' income and explores their views on PBF bonuses, in comparison to and interaction with other incomes.Methods: The study is based on a mixed-methods research consisting in a survey and an 8-week longitudinal logbook collecting data on the incomes of primary health workers (n = 266) and 39 in-depth interviews with a subsample of the same workers, carried out in three districts of Sierra Leone (Bo, Kenema and Moyamba).Results: Our results show that in this setting PBF contributes about 10 % of the total income of health workers. Despite this relatively low contribution, their views on the bonuses are positive, especially compared to the negative views on salary. We find that this is because PBF is seen as a complement, with less sense of entitlement compared to the official salary. Moreover, PBF has a specific role within the income utilization strategies enacted by health workers, as it provides extra money which can be used for emergencies or reinvested in income generating activities. However, implementation issues with the PBF scheme, such as delays in payment and difficulties in access, cause a series of problems that limit the motivational effects of the incentives. Overall, staff still favor salary increases over increases in PBF.Conclusions: The study confirms that the remuneration of health workers is complex and interrelated so that the different financial incentives cannot be examined independently from one. It also shows that the implementation of PBF schemes has an impact on the way it does or does not motivate health workers, and must be thoroughly researched in order to assess the impact of PBF.