Abstract
ABSTRACTBackground: Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. PBF is a reform approach to improve the quality, quantity, and equity of health services and aims at achieving universal health coverage. It focuses on how to best motivate health practitioners.Objective: To elicit physicians’ and nurses’ experiences and views on how PBF influenced and helped them in healthcare delivery.Methods: A qualitative cross-sectional study was carried out among frontline health workers such as physicians and nurses. The data was gathered through individual face-to-face, in-depth, semi-structured interviews with 6 physicians and 30 nurses from February to March 2011 in three hospitals in Gitega Province. A simple framework approach and thematic analysis using a combination of manual technique and MAXQDA software guided the analysis of the interview data.Results: Overall, the interviewees felt that the PBF scheme had provided positive motivation to improve the quality of care, mainly in the structures and process of care. The utilization of health services and the relationship between health practitioners and patients also improved. The salary top-ups were recognized as the most significant impetus to increase effort in improving the quality of care. The small and sometimes delayed financial incentives paid to physicians and nurses were criticized. The findings of this study also indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery.Conclusions: PBF has the potential to motivate medical staff to improve healthcare provision. The views of medical staff and the context of the area of implementation have to be taken into consideration when designing and implementing PBF schemes.
Highlights
Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010
The main themes that emerged from the data analysis were (1) the health quality indicators, (2) the performance evaluation mechanism, (3) the financial incentives payment, (4) the motivation of health workers, (5) the quality of health services, and (6) the utilization of health services
The findings of this study show that PBF motivated and positively influenced physicians and nurses to improve the healthcare provision in the studied health facilities
Summary
Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. The findings of this study indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery. The focus in the present study is on PBF whereby healthcare providers receive financial rewards for improvements in the quantity, quality, and equity of their services according to pre-defined health targets. Many studies propose performance-based incentives as a novel strategy that has the potential to stimulate the improvement of healthcare services [3,7,10], in developing countries where the quality of care is still at a low level [2,4]. The effects of performance-based schemes on improving the healthcare provision depend on different ‘driving’ factors These are the size of incentives, the specific
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