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Signs of P4P enhanced functioning of accountability in the health system: experience from Pwani Pay for Performance (P4P) pilot - Iddy Mayumana

This presentation was given at the pay-for-performance workshop in Tanzania, November 2015

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Signs of P4P enhanced functioning of accountability in the health system: experience from Pwani Pay for Performance (P4P) pilot - Iddy Mayumana

  1. 1. Signs of P4P enhanced functioning of accountability mechanisms in the health system: experience from Pwani Pay for Performance (P4P) pilot Iddy Mayumana
  2. 2. Introduction RBF seen as a policy option to improve providers’ motivation, accountability and performance Little is known about its effects on accountability This study examines the effects of the P4P pilot on accountability mechanisms
  3. 3. Methods Process monitoring (2011-2015) • In-depth interviews (86) • Group interviews (12) • Focus group discussions (18) • Review of relevant documents • Observations during performance feedback meetings conducted
  4. 4. Methods Impact evaluation (2012 and after 2013) • 150 health facilities • Household survey of 3000 women delivered in last 12 months prior to the interview was conducted
  5. 5. Conceptual framework: Cleary et al (2013) Internal accountability:    aims at regulating answerability on the supply side by focusing on accountability within and/or between different levels of the health system, such as management and supervision, as well as budgeting and prioritisation    External accountability : aims at regulating answerability between providers and service users
  6. 6. Internal accountability: Management and Supervision P4P had a positive and significant effect on: • Timeliness of supervision • The provision of positive and negative feedback during supervision. Close supervision improved health data reporting for P4P targeted services Supervision visits aimed at problem solving (drugs, HR issues) – improved relations No significant effect on the number of administrative or managerial meetings held during the last 90 days Improved relations between district and national level stakeholders (less bureucratic) – some staff at district level did not cooperate
  7. 7. Internal accountability: budgeting and prioritisation Score cards and payment to facility accounts enhanced trust P4P entailed a significant reduction of the interruption of service delivery due to broken equipment and in the stock out rate of drugs and medical supplies Funds allocation at the facility level was mainly influenced by a goal to achieve P4P targets
  8. 8. External accountability: to users Health workers more responsive and respectful to their clients Increase in provider kindness reported by patients during delivery, a positive 0.38 point increase in the mean kindness score (95% CI: -0.06 to 0.80). No significant effect of P4P on the proportion of health facilities with a governing committee A positive and significant increase on the probability of having hold a meeting in the last 90 days HFGC involvement was enhanced during P4P fund management (approve the budget) Bonus spent on allowances for committee members
  9. 9. External accountability: to users Health workers reported wanting to increase outreach activities but were hindered by lack of resources No effect on number of outreach activities in the communities in the last 90 days (transport?) When clustering at district level we find a significant increase of 0.52 (SE: 0.0274)  in the number of outreach visits
  10. 10. Conclusions P4P has shown to have the potential to contribute to: • Improving supportive supervision; • Data reporting and verification; • Financial management at the facility level; • Build trust, relationship and teamwork for addressing systemic challenges • Strengthening community oversight mechanisms in public facilities and improve providers’ respect and kindness to their clients
  11. 11. Acknowledgement Co-researchers and contributers Peter Binyaruka Laura Hanselim Irene Mashasi Ikunda Njau Josephine Borghi Masuma Mamdani Siri Lange Funders Norwegian Research Council (GLOBVAC) RESYST

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