Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
Ministry of Health, Kampala, Uganda.
Glob Health Action. 2021 Jan 1;14(1):1919393. doi: 10.1080/16549716.2021.1919393.
: Results-based financing has been promoted as an innovative mechanism to improve the performance of health systems in achieving universal health coverage. Several results-based financing models were implemented in Uganda between 2003 and 2015 but with limited national scale-up.: This paper examines the evolution of results-based financing models and the reasons for the slow national adoption and implementation in Uganda.: This was a qualitative study based on document review and key informant interviews. The models were compared to show modifications overtime. The reasons for the slow national scale-up were analyzed using variables from the Diffusion of Innovations Theory.: This study covered seven schemes implemented in the Ugandan health sector between 2003 and 2015. The models evolved in several aspects: 1) donor reliance with fundholding and purchasing delegated to non-state organizations; 2) establishment of ad-hoc structures for learning; 3) recent involvement of the government agencies in verification processes; 4) Involvement of public providers, and 5) expansion of services purchased from the national minimum health-care package. The main reasons for slow national adoption were the perceived complexity and incompatibility with public sector systems. The early phases comprised barriers to public sector reforms. However, recent adjustments to the schemes have enabled greater involvement of public providers and government stewardship. Stakeholders also reported progressive learning across projects and time.: Overall, the study findings show scheme actors' deliberate efforts to adapt their models to the Ugandan health system and public sector context. Results-based financing is a complex intervention that takes time for the capacity to be built among vital actors. Progressive re-designing of models enhances fitness to the health systems context. From this study, we advise that Uganda and similar countries should undertake deliberate efforts to customize such models to the capacity and institutional architecture of their health systems.
基于成果的融资已被推广为一种创新机制，旨在提高卫生系统实现全民健康覆盖的绩效。2003 年至 2015 年期间，乌干达实施了几种基于成果的融资模式，但在全国范围内的推广规模有限。本文考察了基于成果的融资模式的演变，以及乌干达在全国范围内缓慢采用和实施的原因。这是一项基于文件审查和关键知情者访谈的定性研究。对这些模式进行了比较，以显示其随时间的变化。利用创新扩散理论的变量分析了缓慢在全国范围内推广的原因。本研究涵盖了 2003 年至 2015 年期间在乌干达卫生部门实施的七个计划。这些模式在几个方面发生了演变：1）依赖捐助者，将资金持有和采购权委托给非国家组织；2）为学习建立临时结构；3）最近政府机构参与核查过程；4）公共提供者的参与；5）从国家基本医疗保健一揽子计划中购买的服务扩大。缓慢在全国范围内采用的主要原因是被认为过于复杂，且与公共部门系统不兼容。早期阶段包括对公共部门改革的障碍。然而，最近对这些计划的调整使公共提供者和政府管理有了更大的参与。利益攸关方还报告称，各项目和时间内的学习都在逐步推进。总体而言，研究结果表明，计划参与者有意努力使他们的模式适应乌干达卫生系统和公共部门环境。基于成果的融资是一项复杂的干预措施，需要在重要参与者中建立能力，因此需要时间。模型的逐步重新设计增强了与卫生系统环境的适应性。从这项研究中，我们建议乌干达和类似国家应刻意努力，根据其卫生系统的能力和机构架构定制此类模式。
