Wits Business School, University of the Witwatersrand, Johannesburg, South Africa.
Pan Afr Med J. 2024 Sep 2;49:4. doi: 10.11604/pamj.2024.49.4.43943. eCollection 2024.
suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored.
the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software.
improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.
在大多数发展中国家，捐赠资金使用不足和卫生系统绩效不佳的情况普遍存在；为了解决这个问题，开发了基于成果的融资（RBF）模式。然而，探索基于成果的融资对卫生系统绩效的内在和具体影响是至关重要的。因此，本研究旨在探讨基于成果的融资对卫生工作者激励和治理、时间视角、分配原则和政策一致性的影响。最后，还探讨了基于成果的融资对捐助者、技术合作伙伴和卫生工作者之间相互关系的影响。
该研究采用定性、探索性、描述性、现象学设计，使用录音的面对面半结构化访谈，从剩余的和现有的两名卫生融资专家、两名技术合作伙伴组织代表以及六名自 2011 年至 2022 年在津巴布韦马隆德拉区实施基于成果的融资的卫生工作者那里获取不同的观点。数据使用 NVIVO 软件进行转录和集体分析。
尽管存在一些挑战，如人员不足、工作量增加、采购繁琐、财务僵化和补贴支付延迟，这些都削弱了绩效改善的成果，但基于成果的融资提高了员工的积极性、改善了治理、促进了卫生系统的发展、实现了公平性并保持了政策的一致性。此外，还观察到由于穷人在更高层次的护理中面临的自付费用而导致的护理连续性不足，以及捐助者和医疗机构工作人员之间的有限参与。强调已实现的积极成果对于维持实现的健康收益至关重要；然而，需要紧急关注解决这些挑战，以保障迄今取得的里程碑。
