Bhatnagar Aarushi, George Asha S
Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
Health Policy Plan. 2016 Sep;31(7):868-77. doi: 10.1093/heapol/czw002. Epub 2016 Mar 5.
In 2012, the Nigerian government launched performance-based financing (PBF) in three districts providing financial incentives to health workers based on the quantity and quality of service provision. They were given autonomy to use funds for operational costs and performance bonuses. This study aims to understand changes in perceived motivation among health workers with the introduction of PBF in Wamba district, Nigeria.
The study used a qualitative research design to compare perceptions of health workers in facilities receiving PBF payments in the pilot district of Wamba to those that were not. In-depth semi-structured interviews (n = 39) were conducted with health workers from PBF and non-PBF facilities along with managers of the PBF project. Framework analysis was used to identify patterns and variations in responses. Facility records were collated and triangulated with qualitative data.
Health workers receiving PBF payments reported to be 'awakened' by performance bonuses and improved working environments including routine supportive supervision and availability of essential drugs. They recounted being more punctual, hard working and proud of providing better services to their communities. In comparison, health workers in non-PBF facilities complained about the dearth of basic equipment and lack of motivating strategies. However, health workers from both sets of facilities considered there to be a severe shortage of manpower resulting in excessive workload, fatigue and general dissatisfaction.
PBF strategies can succeed in motivating health workers by bringing about a change in incentives and working conditions. However, such programmes need to be aligned with human resource reforms including timely recruitment and appropriate distribution of health workers to prevent burn out and attrition. As people working on the frontline of constrained health systems, health workers are responsive to improved incentives and working conditions, but need more comprehensive support.
2012年，尼日利亚政府在三个地区推行基于绩效的融资（PBF），根据服务提供的数量和质量向卫生工作者提供经济激励。他们被赋予自主使用权，可将资金用于运营成本和绩效奖金。本研究旨在了解在尼日利亚万巴地区引入PBF后，卫生工作者感知到的动机变化。
本研究采用定性研究设计，比较万巴试点地区接受PBF付款设施中的卫生工作者与未接受付款设施中的卫生工作者的看法。对来自PBF设施和非PBF设施的卫生工作者以及PBF项目管理人员进行了深入的半结构化访谈（n = 39）。采用框架分析法识别回答中的模式和差异。整理了机构记录，并与定性数据进行三角验证。
接受PBF付款的卫生工作者报告称因绩效奖金和工作环境改善而“被唤醒”，工作环境改善包括常规支持性监督和基本药物的供应。他们讲述自己更加守时、努力工作，并为向社区提供更好的服务而感到自豪。相比之下，非PBF设施中的卫生工作者抱怨基本设备短缺和缺乏激励策略。然而，两组设施中的卫生工作者都认为人力严重短缺，导致工作量过大、疲劳和普遍不满。
PBF策略可以通过改变激励措施和工作条件成功激励卫生工作者。然而，此类计划需要与人力资源改革保持一致，包括及时招聘和合理分配卫生工作者，以防止倦怠和人员流失。作为在资源有限的卫生系统前线工作的人员，卫生工作者对改善激励措施和工作条件有反应，但需要更全面的支持。
