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báo cáo sinh học:" Paying health workers for performance in Battagram district, Pakistan"

Tuyển tập các báo cáo nghiên cứu về sinh học được đăng trên tạp chí sinh học quốc tế đề tài : Paying health workers for performance in Battagram district, Pakistan | Witter et al. Human Resources for Health 2011 9 23 http www.human-resources-health.eom content 9 1 23 HUMAN RESOURCES ulli FOR HEALTH RESEARCH Open Access Paying health workers for performance in Battagram district Pakistan Sophie Witter1 2 Tehzeeb Zulfiqur3 Sarah Javeed4 Amanullah Khan5 and Abdul Bari6 Abstract Background There is a growing interest in using pay-for-performance mechanisms in low and middle-income countries in order to improve the performance of health care providers. However at present there is a dearth of independent evaluations of such approaches which can guide understanding of their potential and risks in differing contexts. This article presents the results of an evaluation of a project managed by an international nongovernmental organisation in one district of Pakistan. It aims to contribute to learning about the design and implementation of pay-for-performance systems and their impact on health worker motivation. Methods Quantitative analysis was conducted of health management information system HMIS data financial records and project documents covering the period 2007-2010. Key informant interviews were carried out with stakeholders at all levels. At facility level in-depth interviews were held as were focus group discussions with staff and community members. Results The wider project in Battagram had contributed to rebuilding district health services at a cost of less than US 4.5 per capita and achieved growth in outputs. Staff managers and clients were appreciative of the gains in availability and quality of services. However the role that the performance-based incentive PBI component played was less clear-PBI formed a relatively small component of pay and did not increase in line with outputs. There was little evidence from interviews and data that the conditional element of the PBIs influenced behaviour. They were appreciated as a top-up to pay but remained low in relative terms and only slightly and indirectly related to individual .