Investigating the determinants of health worker performance in Senegal

培训、激励和留住专业卫生工作者对于改善卫生成果至关重要，特别是在低收入和中等收入国家，卫生工作者表现不佳被认为是实现更好卫生成果的主要障碍之一。为了提高工作人员的积极性和业绩，许多捐助者和政府最近支持采用基于业绩的筹资机制，将卫生工作者的部分薪酬与业绩目标挂钩。虽然令人鼓舞的结果表明，这些方案可以改善保健服务的利用率和某些保健成果，但尚不清楚它们对保健工作者的动机和行为有何具体影响。然而，关键是要更好地了解PBF如何为卫生工作者工作，特别是是否卫生工作者的绩效的所有方面都得到了改善，或者PBF是否会引起一些不良影响，例如减少与每个病人在一起的时间，拟议研究的目的是产生新的知识和理解PBF方案如何工作和影响卫生工作者的绩效。这项拟议的研究利用了世界银行2014年在塞内加尔四个最贫穷和最农村地区开展的准实验性研究。该项目将收集控制和PBF设施中的一组丰富的原始数据，以回答几个关键问题。研究将首先进行一些访谈，以评估PBF计划中计划的内容在多大程度上实际上是实践中正在发生的。这将有助于准确理解正在实施的干预措施的性质。然后，该研究将进行一项大规模调查，收集控制和PBF设施中关于工作环境和卫生保健工作者的特点、行为和业绩的信息。其目的是确定PBF的影响，通过比较的业绩和行为的卫生工作者与PBF的奖励和不。具体而言，调查将探讨PBF是否提高了生产力，提供的护理质量和对病人的态度。收集的数据还将有助于确定PBF是否会增加花费在每位患者身上的时间和精力，以及是否会减少非激励活动。最后，通过收集到的信息，我们将能够确定卫生工作者业绩变化的机制。

Training, motivating and retaining professional health workers is crucial for the improvement of health outcomes, especially in low and middle-income countries where poor health worker performance has been recognised as one of the key obstacles to achieving better health outcomes. To improve staff motivation and performance, many donors and governments have recently supported the introduction of Performance-Based Financing (PBF) mechanisms, which link part of the health workers' remuneration to performance targets. While promising results have shown that these programmes can improve utilisation of health services and some health outcomes, it is still unclear what specific effects they have on the motivation and behaviours of health workers. Yet it is key to understand better how PBF works for health workers, and in particular whether all aspects of health workers' performance have improved or whether PBF can induce some undesired effects, e.g. a reduction in time spent with each patient.The aim of the proposed research is to generate new knowledge and understanding of how PBF programmes work and influence health workers' performance. The proposed research takes advantage of a quasi-experimental study introduced by the World Bank in four of the poorest and most rural regions of Senegal in 2014. The project will collect a rich set of primary data in control and PBF facilities to answer several critical questions.The research will first undertake some interviews to assess whether the extent to which what was planned in the PBF scheme is actually what is happening in practice. This will help understand exactly the nature of the intervention being implemented. The research will then undertake a large survey, collecting information in control and PBF facilities on the working environment and characteristics, behaviours and performance of health care workers. The aim is to determine the effects of PBF, by comparing the performance and behaviours of health workers with and without PBF incentives. Specifically, the survey will explore whether PBF improves the productivity, quality of care provided and attitude towards patients. The data collected will also help determine whether the time and effort spent on each patient increase and on non-incentivised activities decrease as a result of the PBF. Finally, with the information collected, we will be able to identify mechanisms through which the performance of health workers changes.