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结果至关重要，特别是在低收入和中等收入国家，在这些国家，卫生工作者业绩不佳被认为是实现更好卫生结果的关键障碍之一。为了提高工作人员的积极性和绩效，许多捐助者和政府最近支持引入基于绩效的筹资(PBF)机制，将卫生工作者的部分薪酬与绩效目标挂钩。虽然有希望的结果表明，这些方案可以改善卫生服务的利用率和一些卫生成果，但尚不清楚它们对卫生工作者的动机和行为有什么具体影响。然而，关键是要更好地了解PBF对卫生工作者的作用方式，特别是卫生工作者各方面的表现是否有所改善，或者PBF是否会产生一些不受欢迎的影响，例如减少与每个患者相处的时间。拟议研究的目的是产生关于PBF计划如何工作并影响卫生工作者业绩的新知识和理解。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引入的准实验研究。该项目将收集一组丰富的控制和PBF设施的基本数据，以回答几个关键问题。研究将首先进行一些访谈，以评估PBF计划中计划的程度是否实际正在发生。这将有助于准确理解正在实施的干预的性质。然后，研究将进行一项大型调查，收集控制和PBF设施中关于卫生保健工作者的工作环境和特征、行为和表现的信息。其目的是通过比较有无PBF激励的卫生工作者的绩效和行为来确定PBF的效果。具体地说，调查将探讨PBF是否会改善生产力、提供的护理质量和对患者的态度。收集的数据还将有助于确定花在每个患者身上的时间和精力是否会因为PBF而增加，以及花在非激励性活动上的时间和精力是否会减少。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.