Abstract
BackgroundPrompted by the need to achieve progress in health outcomes, payment for performance (P4P) schemes are becoming popular policy options in the health systems in many low income countries. This paper describes the policy process behind the introduction of a payment for performance scheme in the health sector of Tanzania illuminating in particular the interests of and roles played by the Government of Norway, the Government of Tanzania and the other development partners.MethodsThe study employed a qualitative research design using in-depth interviews (IDIs), observations and document reviews. Thirteen IDIs with key-informants representing the views of ten donor agencies and government departments influential in the process of introducing the P4P scheme in Tanzania were conducted in Dar es Salaam, Tanzania and Oslo, Norway. Data was collected on the main trends and thematic priorities in development aid policy, countries and actors perceived to be proponents and opponents to the P4P scheme, and P4P agenda setting in Tanzania.ResultsThe initial introduction of P4P in the health sector of Tanzania was controversial. The actors involved including the bilateral donors in the Health Basket Fund, the World Bank, the Tanzanian Government and high level politicians outside the Health Basket Fund fought for their values and interests and formed alliances that shifted in the course of the process. The process was characterized by high political pressure, conflicts, changing alliances, and, as it evolved, consensus building.ConclusionThe P4P policy process was highly political with external actors playing a significant role in influencing the agenda in Tanzania, leaving less space for the Government of Tanzania to provide leadership in the process. Norway in particular, took a leading role in setting the agenda. The process of introducing P4P became long and frustrating causing mistrust among partners in the Health Basket Fund.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0125-9) contains supplementary material, which is available to authorized users.
Highlights
Prompted by the need to achieve progress in health outcomes, payment for performance (P4P) schemes are becoming popular policy options in the health systems in many low income countries
The actors involved, including the bilateral donors in the Health Basket Fund, the World Bank, the Government of Tanzania and high level politicians outside the Health Basket Fund, fought for their values and interests and formed alliances that shifted in the course of the process
The idea of P4P in Tanzania originated from the Norwegian-Tanzanian health sector partnership initiative (NTPI) which was signed in 2007 by the President of Tanzania and the Norwegian Prime Minister
Summary
Prompted by the need to achieve progress in health outcomes, payment for performance (P4P) schemes are becoming popular policy options in the health systems in many low income countries. There are a number of arguments for and against the use of provider P4P mechanism in the health sector of low income countries and both these arguments are supported by empirical studies. It is argued that P4P can facilitate the Chimhutu et al Globalization and Health (2015) 11:38 pooling and integration of resources and improve efficiency and the potential spill-over effect into the whole public sector in low income countries [2]. A study carried out in Rwanda concluded that P4P can be an effective tool to strengthen the quality and the use of maternal and child health services [4]. The evidence available on P4P schemes in health care is inconclusive and cannot be documented across settings [9]
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