Protocol for the evaluation of a quality-based pay for performance scheme in Liberia

Area of Science:

• Health Systems Strengthening
• Quality Improvement in Healthcare
• Human Resources for Health

Background:

• Liberia's health system requires improved hospital quality of care.
• Initiatives include upgrading health worker skills and provider accountability.
• Key programs are the Graduate Medical Residency Program (GMRP) and performance-based financing (PBF).

Purpose of the Study:

• To evaluate the impact of a hospital improvement program in Liberia.
• To understand the mechanisms driving successful quality improvements.
• To derive generalizable lessons for low-income country healthcare.

Main Methods:

• Protocol for an impact evaluation of a hospital improvement program.
• Three-period intensive evaluation of treated and matched comparison hospitals.
• Continuous data collection on health worker activities within treated hospitals.

Main Results:

• Focus on changes in hospital human resources.
• Quantitative description of facility-level changes due to the program.
• Analysis of how quality targets were met.

Conclusions:

• Investigating the recruitment of qualified health workers.
• Assessing improvements in staff knowledge and competence.
• Examining the role of medicines, equipment, and worker motivation in quality enhancement.
• Determining patient perception of quality improvements.