Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France.
École doctorale Pierre Louis de santé publique, Université de Paris, Paris, France.
Glob Health Res Policy. 2021 Feb 2;6(1):5. doi: 10.1186/s41256-021-00189-0.
Performance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating health workers. The purpose of this research was to identify and understand how health workers' expectations related to their experiences of the first cycle of payment of PBF subsidies, and how this experience affected their motivation and sentiments towards the intervention. We pose the research question, "how does the process of PBF subsidies impact the motivation of health workers in Mali?"
We adopted a qualitative approach using multiple case studies. We chose three district hospitals (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each DH. We analyzed data in a mixed deductive and inductive manner.
The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work more efficiently. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention.
The PBF implementation in Mali left health workers frustrated. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. This underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.
绩效激励型融资（PBF）是一项创新的卫生融资举措，最近在马里实施。PBF 的目的是通过激励卫生工作者来提高护理质量。本研究旨在确定并理解卫生工作者对其首次 PBF 补贴支付周期的经验相关期望，以及这种经验如何影响他们对干预措施的动机和感受。我们提出的研究问题是，“PBF 补贴的实施过程如何影响马里卫生工作者的动机？”
我们采用了定性方法，使用了多个案例研究。我们选择了三个地区医院（DH1、2 和 3），位于三个卫生区（1、2 和 3 区），在库利科罗地区的十个卫生区中。我们的案例对应于这三个 DH。我们遵循数据源三角验证原则；我们对卫生工作者进行了 53 次半结构化访谈（以遵循饱和原则），并进行了实地记录和与每个 DH 的补贴分配网格相关的文件。我们采用了混合演绎和归纳的方法分析数据。
结果表明，PBF 补贴总体上使卫生工作者感到更有动力履行任务。除了经济激励之外，这主要是因为 PBF 使他们能够更有效地工作。然而，受访者认为他们的努力和所获得的补贴之间存在差距。他们的期望没有得到满足导致了挫败感和失望感。同样，补贴的分配方式以及分配过程缺乏透明度导致绝大多数受访者感到不公平。结果表明，在干预的早期阶段，挫败感可能会逐渐积累。
马里的 PBF 实施使卫生工作者感到沮丧。总体实施周期较短，使参与者无法调整他们最初的期望和激励反应，无论是积极的还是消极的。这突显了短期干预措施不仅可能缺乏影响力，而且可能会产生可能持续到未来的负面情绪。
