Performance-based financing kick-starts motivational "feedback loop": findings from a process evaluation in...

Area of Science:

• Health Systems Strengthening
• Public Health Policy
• Behavioral Economics in Healthcare

Background:

• Performance-based financing (PBF) reforms aim to modify health worker behavior through institutional, accountability, and financial incentive changes.
• PBF influences both extrinsic and intrinsic motivators, affecting health worker engagement and performance.
• This study evaluates a PBF program in Mozambique, examining its impact on internal and external drivers of health worker motivation.

Purpose of the Study:

• To explore perceived changes in internal and external motivational drivers for health workers under a PBF program.
• To understand the interplay between different motivational factors stimulated by PBF.
• To provide insights for designing and refining PBF programs to enhance health worker motivation.

Main Methods:

• Qualitative research design utilizing in-depth, semi-structured interviews with health workers.
• Inclusion of a rank order exercise and focus group discussions to gather comprehensive data.
• Thematic analysis by two researchers for interview data; weighted average methodology for rank order frequency.

Main Results:

• Health workers reported that PBF positively influenced motivation by reinforcing internal and external drivers.
• Internal drivers enhanced: self-efficacy, goal orientation, collegial competition, and job satisfaction.
• External drivers enhanced: organized work environment, improved access to supplies/equipment, financial incentives, teamwork, and supervision.

Conclusions:

• PBF fosters a positive feedback loop between responsibility, achievement, and recognition, boosting perceived motivation.
• Financial incentives can initiate this motivational feedback loop in resource-limited settings.
• Policymakers should assess and potentially implement PBF to enhance health worker motivation and accountability.