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Does the gap between health workers’expectations and the realities of implementing a performance-based financing project in Mali create frustration?

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Global Health Research and Policy 2021年第1期6卷 468-477页

作者： Tony Zitti Amandine Fillol julia lohmann Abdourahmane Coulibaly Valéry Ridde Centre Population et Développement(Ceped) Institut de recherche pour le développement(IRD)et Universitéde ParisInserm ERL 124445 rue des Saints-Pères75006 ParisFrance École doctorale Pierre Louis de santépublique Universitéde ParisParisFrance ONG Miseli BamakoMali Ecole de santépublique de l’Universitéde Montréal MontréalCanada London School of Hygiene&Tropical Medicine LondonUK Heidelberg Institute of Global Health Medical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany Facultéde Médicine et d’Odontostomatologie Universitédes Sciencesdes Techniques et des TechnologiesBamakoMali

Background:Performance-Based Financing(PBF),an innovative health financing initiative,was recently implemented in *** aims to improve quality of care by motivating health *** 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 *** pose the research question,“how does the process of PBF subsidies impact the motivation of health workers in Mali?”Methods:We adopted a qualitative approach using multiple case *** chose three district hospitals(DH 1,2 and 3)in three health districts(district 1,2 and 3)among the ten in the Koulikoro *** cases correspond to the three *** 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 *** analyzed data in a mixed deductive and inductive ***:The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks *** financial motivation,this was primarily due to PBF allowing them to work more ***,respondents perceived a discrepancy between the efforts made and the subsidies *** fact that their expectations were not met led to a sense of frustration and ***,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 *** results show that frustrations can build up in the early days of the ***:The PBF implementation in Mali left health workers *** short overall implementation period did not allow actors to adjust their initial expectations and motivational responses,neither positiv

关键词： Motivation of health workers Performance-based financing District hospital expectations Frustration Mali

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