Chimhutu Victor, Tjomsland Marit, Songstad Nils Gunnar, Mrisho Mwifadhi, Moland Karen Marie
Department of Health Promotion and Development, University of Bergen, P.O Box 7807, 5020, Bergen, Norway.
Faculty of Social Sciences, University of Bergen, P.O Box 7802, 5020, Bergen, Norway.
Global Health. 2015 Sep 2;11:38. doi: 10.1186/s12992-015-0125-9.
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. 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.
The 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.
The 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.
The 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.
受实现健康成果进展需求的推动，绩效薪酬（P4P）计划正成为许多低收入国家卫生系统中流行的政策选择。本文描述了坦桑尼亚卫生部门引入绩效薪酬计划背后的政策过程，特别阐明了挪威政府、坦桑尼亚政府及其他发展伙伴的利益和所发挥的作用。
本研究采用定性研究设计，运用深入访谈、观察和文件审查。在坦桑尼亚达累斯萨拉姆和挪威奥斯陆，对13名关键 informant 进行了深入访谈，他们代表了在坦桑尼亚引入P4P计划过程中有影响力的10个捐助机构和政府部门的观点。收集了关于发展援助政策的主要趋势和主题重点、被视为P4P计划支持者和反对者的国家及行为体，以及坦桑尼亚P4P议程设定的数据。
坦桑尼亚卫生部门最初引入P4P存在争议。参与其中的行为体，包括卫生篮子基金中的双边捐助方、世界银行、坦桑尼亚政府以及卫生篮子基金之外的高级别政治家，为自身价值观和利益而争斗，并形成了在过程中不断变化的联盟。该过程的特点是政治压力大、冲突不断、联盟关系变化，且随着发展形成了共识。
P4P政策过程极具政治性，外部行为体在影响坦桑尼亚议程方面发挥了重要作用，留给坦桑尼亚政府在该过程中发挥领导作用的空间较小。特别是挪威在议程设定方面发挥了主导作用。引入P4P的过程变得漫长且令人沮丧，导致卫生篮子基金中的伙伴之间产生不信任。
