“I wanted a skeleton … they brought a prince”
A qualitative investigation of factors mediating the implementation of a Performance Based Incentive program in Malawi
Bibliographic Data
| ID | 17827147 |
|---|---|
| Authors | Shannon A Mcmahon (0000-0002-8634-9283, Heidelberg University, corresponding author), Adamson S Muula (0000-0003-4412-9773, University of Malawi), Manuela De Allegri (0000-0002-8677-1337, Heidelberg University) |
| Year | 2018 |
| Volume | 5 |
| Pages | 64-72 |
| Publication date | 2018-04-23 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | SSM - Population Health (JOURNAL) |
| Journal identifiers | ISSN: 2352-8273 • E-ISSN: 2352-8273 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.ssmph.2018.04.006 |
| PMID | 30023425 |
| OpenAlex | W2801249994 |
| Language | EN |
| Citations received | 4 |
| References cited | 36 |
While several evaluations have examined the extent to which performance based financing (PBF) programs induce changes in the quantity and quality of health services provided, less is known about the process of implementing PBF. We conducted a process evaluation of a PBF intervention in Malawi that focused on understanding moderators of program implementation. Informed by a seminal theory of implementation, we first created a timeline and taxonomy of key events in the program lifeline and then undertook 25 in-depth interviews with stakeholders including implementers, central-level ministry officials and district-level health staff. While seven "moderator categories" emerged in this study, two categories (program complexity and quality of delivery) proved especially crucial in terms of moderating implementation and sparking adaptations. Complexity refers primarily to the manner in which PBF requires that those implementing the program have business acumen and forecasting skills, which are often beyond the purview of a clinician's training and thus proved challenging. Regarding quality of delivery, the program struggled to issue rewards in a timely and adequate manner, which proved highly problematic as it undermined a bedrock feature of PBF. Adaptations and adaptability refers here to a program's ability to make changes; the program proved rigid in several respects although nimble in terms of adjusting the verification process (upon noticing revengeful behaviors in peer verification). This PBF program is unique in several respects and findings cannot be generalized to all PBF programs. Nevertheless, process evaluations that draw from or expand upon existing implementation theories can allow researchers to better disentangle complex programming. We hope that more process evaluations, which track both core elements and necessary adaptations of PBF implementation, can further advance understandings of why PBF implementation functions or fails within a given setting, thereby enhancing implementers' abilities to replicate facilitators and bypass barriers
Economics · Incentive · Incentive program · Microeconomics · Operations management · Programming language · Computer Science · Global Maternal and Child Health · Healthcare Policy and Management · Primary Care and Health Outcomes
Using implementation science theories and frameworks in global health
To the bone
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Why did performance-based financing in Burkina Faso fail to achieve the intended equity effects? A process tracing study
A conceptual framework for implementation fidelity
Countdown to 2015
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance
An Ecological Perspective on Health Promotion Programs
Pay For Performance
Introducing payment for performance in the health sector of Tanzania- the policy process
Opening the ‘black box’ of performance-based financing in low- and lower middle-income countries
Evaluation a systematic approach
Tracking implementation and (un)intended consequences
Studying the link between institutions and health system performance
Reforming the health sector in developing countries
Motivating health workers up to a limit
Pay for performance in Nigeria
Using thematic analysis in psychology
The effects of performance incentives on the utilization and quality of maternal and child care in Burundi
Paying for performance and the social relations of health care provision
Why performance-based contracting failed in Uganda - An "open-box" evaluation of a complex health system intervention
The unintended consequences of community verifications for performance-based financing in Burkina Faso
Understanding job satisfaction amongst mid-level cadres in Malawi
| Unique citing works | 4 |
|---|---|
| Citations per year | 0,57 |
| Citation span | 2019 - 2022 (4) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 4 |