How does performance-based financing affect health workers' intrinsic motivation? A Self-Determination Theory-based...

Area of Science:

• Health Systems Research
• Behavioral Economics
• Public Health Interventions

Background:

• Performance-based Financing (PBF) is increasingly used to improve healthcare delivery.
• A potential unintended consequence of PBF is
• intrinsic motivation crowding out,
• where financial incentives may erode intrinsic motivation.
• Little research has empirically investigated this phenomenon in PBF contexts.

Purpose of the Study:

• To investigate the impact of PBF on health workers' intrinsic motivation in Malawi.
• To explore the mechanisms through which PBF affects intrinsic motivation, guided by Self-Determination Theory (SDT).

Main Methods:

• A mixed-methods approach combining quantitative (pre- and post-test controlled design) and qualitative (in-depth interviews) data.
• Quantitative data collected from health workers in PBF intervention and comparison facilities.
• Qualitative data explored the impact of PBF on psychological needs (autonomy, competence, relatedness) central to SDT.

Main Results:

• PBF did not significantly alter overall intrinsic motivation levels among health workers.
• The PBF intervention demonstrated both positive and negative effects on the satisfaction of basic psychological needs.
• Qualitative findings provided insights into how PBF elements influenced these needs.

Conclusions:

• PBF's introduction in Malawi did not lead to a widespread erosion of intrinsic motivation.
• Strategies to support autonomy and mitigate negative impacts are crucial for maximizing PBF's motivational benefits.
• Further research should focus on designing PBF to sustain intrinsic motivation.