Abstract
Background: To improve the performance of the healthcare system, Mali’s government implemented a pilot project of performance-based financing (PBF) in the field of reproductive health. It was established in the Koulikoro region. This research analyses the process of implementing PBF at district hospital (DH) level, something which has rarely been done in Africa. Methods: This qualitative research is based on a multiple, explanatory, and contrasting case study with nested levels of analysis. It covered three of the 10 DHs in the Koulikoro region. We conducted 36 interviews: 12 per DH with council of circle’s members (2) and health personnel (10). We also conducted 24 non-participant observation sessions, 16 informal interviews, and performed a literature review. We performed data analysis using the Consolidated Framework for Implementation Research (CFIR). Results: Stakeholders perceived the PBF pilot project as a vertical intervention from outside that focused solely on reproductive health. Local actors were not involved in the design of the PBF model. Several difficulties regarding the quality of its design and implementation were highlighted: too short duration of the intervention (8 months), choice and insufficient number of indicators according to the priority of the donors, and impossibility of making changes to the model during its implementation. All health workers adhered to the principles of PBF intervention. Except for members of the district health management team (DHMT) involved in the implementation, respondents only had partial knowledge of the PBF intervention. The implementation of PBF appeared to be easier in District 3 Hospital compared to District 1 and District 2 because it benefited from a pre-pilot project and had good leadership. Conclusion: The PBF programme offered an opportunity to improve the quality of care provided to the population through the motivation of health personnel in Mali. However, several obstacles were observed during the implementation of the PBF pilot project in DHs. When designing and implementing PBF in DHs, it is necessary to consider factors that can influence the implementation of a complex intervention.
Highlights
Performance-based financing (PBF) is a mechanism by which health facilities are paid on the basis of their performance, which is measured by the quantity and quality of services they provide.[1]
Our results feature a general analysis of the implementation of performance-based financing (PBF) in district hospital (DH) in Mali
Respondents among district health management team (DHMT) members involved in the implementation knew that the World Bank funded the PBF intervention
Summary
Performance-based financing (PBF) is a mechanism by which health facilities are paid on the basis of their performance, which is measured by the quantity and quality of services they provide.[1]. In Cameroon, a study by De Allegri et al[15] revealed that the delay due to the payment of PBF bonus payments did not allow the health centre to have effective management autonomy, to execute their plans, and to cover the costs of taking care of the very poor. The majority of articles on the implementation of the PBF in Africa[11,12,16] either featured a wide range of health facilities (dispensaries, health posts, health centres, and hospitals) or just focused on primary health centres
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