Exploring the influence of context on complex, health system strengthening interventions: a mixed methods study of Performance-based financing in Zamb

基于绩效的筹资是一组复杂的供应方改革方案，旨在改善卫生系统的绩效。虽然其独特的组成部分是与服务和质量措施挂钩的对保健提供者的财政奖励，但也包括其他相互作用的组成部分，如加强监督、更多的支出自主权或培训。建设和平基金在低收入和中等收入国家迅速扩大，但其影响的证据各不相同。背景，即围绕干预措施的实施和运作并与之相互作用的一系列特征和情况，可能会影响建设和平基金各组成部分在不同环境中的实施和效力。文献指出了影响执行和有效性的不同背景因素，包括设施和更广泛的卫生系统的财政、人力和物力资源，PBF所针对的服务需求的障碍以及更广泛的因素，如准则和条例。还提出了各组成部分之间相互作用和适应环境的重要性。然而，迄今为止，大多数研究只集中在一对夫妇的组件，并没有探讨什么是影响不同的PBF组件的执行和有效性的背景因素之间的差异。此外，到目前为止，还没有使用定性研究来为现有影响评价数据的分析提供信息。本研究将探讨情境如何影响PBF的介入实施与成效。研究的主要重点将是建设和平基金在赞比亚进行的妇幼保健干预。这项研究将包括，首先，对据报影响低收入国家孕产妇保健方案基金干预措施的实施和有效性的背景因素进行系统审查。第二，一个案例研究，涉及主要的定性数据收集，目前影响PBF在赞比亚地区的实施和有效性的背景因素的特点。第三，影响评估数据的二级数据分析。这个项目将有助于对复杂干预措施的评估领域的知识，使我能够发展我的技能：- 案例研究和定性研究的实施和分析-影响评估数据的使用-系统评价和叙述性综合的技能-提高定量技能（使用Stata分析影响评估数据，差异分析中的差异，亚组分析）-使用混合方法与社会科学之间的交叉，该方法将联合收割机定性（访谈）和定量数据。关键词：过程评估、影响评估、基于绩效的融资、案例研究、复杂干预措施、加强卫生系统、背景、实施、低收入国家、实施科学、混合方法、健康记录、常规数据，调查、定量、定性、知识转移。

Performance-based financing (PBF) is a group of complex supply-side reform packages to improve performance in the health system. Although their distinctive component are the financial incentives for health providers linked to services and quality measures, they also include other interacting components such as enhanced supervision, more spending autonomy or training. PBF has expanded quickly across low and middle-income countries, however, evidence on impact has been variable. Context, the set of characteristics and circumstances that surround and interact with the implementation and functioning of an intervention, is likely to influence the implementation and effectiveness of PBF components in different settings. The literature points at different contextual factors influencing implementation and effectiveness, including financial, human and material resources in the facility and the broader health system, barriers to the demand of services targeted by PBF and broader factors such as guidelines and regulations. The importance of interactions between components and adapting to context has also been suggested. However, most research so far has focused only on a couple of components and has not explored what are the differences between the contextual factors influencing implementation and effectiveness of the different PBF components. Moreover, qualitative research has not been used to inform the analyses of existing impact evaluation data so far. This research will explore how the context influences intervention's implementation and effectiveness in PBF. The primary focus of study will be a PBF intervention for maternal and child health conducted in Zambia. The research will include, first, a systematic review on contextual factors reported to influence the implementation and effectiveness of PBF interventions for maternal health in LMICs. Second, a case study involving primary qualitative data collection to characterize the contextual factors currently influencing the implementation and effectiveness of PBF in a Zambian district. Third, a secondary data analysis of impact evaluation data.This project will contribute to knowledge on the field of evaluation of complex interventions, allowing me to develop my skills in: - Process evaluation. - The conduction and analysis of case studies and qualitative research- The use of impact evaluation data- Skills on systematic reviews and narrative synthesis- Advance quantitative skills (analysing impact evaluation data with Stata, Difference in differences analysis, subgroup analysis)- The cross-over between with social sciences using mixed methods that combine qualitative (interviews) and quantitative data.Keywords: Process evaluation, impact evaluation, performance-based financing, case study, complex interventions, health systems strengthening, context, implementation, LMICs, implementation science, mixed methods, health records, routine data, surveys, quantitative, qualitative, knowledge transfer.