2023-09-28 14:46:10 +00:00
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abstract: 'Although pay-for-performance (P4P) schemes have been implemented across
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low- and middle-income countries (LMICs), little is known about their
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distributional consequences. A key concern is that financial bonuses are
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primarily captured by providers who are already better able to perform
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(for example, those in wealthier areas), P4P could exacerbate existing
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inequalities within the health system. We examine inequalities in the
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distribution of pay-outs in Zimbabwe''s national P4P scheme (2014-2016)
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using quantitative data on bonus payments and facility characteristics
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and findings from a thematic policy review and 28 semi-structured
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interviews with stakeholders at all system levels. We found that in
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Zimbabwe, facilities with better baseline access to guidelines, more
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staff, higher consultation volumes and wealthier and less remote target
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populations earned significantly higher P4P bonuses throughout the
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programme. For instance, facilities that were 1 SD above the mean in
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terms of access to guidelines, earned 90 USD more per quarter than those
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that were 1 SD below the mean. Differences in bonus pay-outs for
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facilities that were 1 SD above and below the mean in terms of the
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number of staff and consultation volumes are even more pronounced at 348
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USD and 445 USD per quarter. Similarly, facilities with villages in the
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poorest wealth quintile in their vicinity earned less than all
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others-and 752 USD less per quarter than those serving villages in the
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richest quintile. Qualitative data confirm these findings. Respondents
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identified facility baseline structural quality, leadership, catchment
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population size and remoteness as affecting performance in the scheme.
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Unequal distribution of P4P pay-outs was identified as having negative
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consequences on staff retention, absenteeism and motivation. Based on
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our findings and previous work, we provide some guidance to policymakers
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on how to design more equitable P4P schemes.'
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affiliation: 'Borghi, J (Corresponding Author), London Sch Hyg \& Trop Med, Dept Global
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Hlth \& Dev, 15-17 Tavistock Pl, London WC1H 9SH, England.
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Kovacs, Roxanne; Borghi, Josephine, London Sch Hyg \& Trop Med, Fac Publ Hlth \&
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Policy, Dept Global Hlth \& Dev, 15-17 Tavistock Pl, London WC1H 9SH, England.
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Brown, Garrett W., Univ Leeds, Sch Polit \& Int Studies POLIS, Woodhouse Leeds LS2
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9JT, England.
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Kadungure, Artwell, Training \& Res Support Ctr TARSC, Harare, Zimbabwe.
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Kristensen, Soren R., Univ Southern Denmark, Danish Ctr Hlth Econ, DK-5000 Odense
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C, Denmark.
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Kristensen, Soren R., Imperial Coll London, Fac Med, Inst Global Hlth Innovat, London
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SW7 2AZ, England.
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Gwati, Gwati, Minist Hlth \& Child Care, Harare, Zimbabwe.
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Anselmi, Laura, Univ Manchester, Hlth Serv Res \& Primary Care, Div Populat Hlth,
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Manchester M13 9NT, Lancs, England.
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Midzi, Nicholas, Minist Hlth \& Child Care, Natl Inst Hlth Res, Harare, Zimbabwe.'
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author: Kovacs, Roxanne and Brown, Garrett W. and Kadungure, Artwell and Kristensen,
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Soren R. and Gwati, Gwati and Anselmi, Laura and Midzi, Nicholas and Borghi, Josephine
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author-email: Josephine.Borghi@lshtm.ac.uk
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author_list:
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- family: Kovacs
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given: Roxanne
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- family: Brown
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given: Garrett W.
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- family: Kadungure
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given: Artwell
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- family: Kristensen
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given: Soren R.
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- family: Gwati
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given: Gwati
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- family: Anselmi
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given: Laura
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- family: Midzi
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given: Nicholas
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- family: Borghi
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given: Josephine
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da: '2023-09-28'
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doi: 10.1093/heapol/czab154
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earlyaccessdate: JAN 2022
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eissn: 1460-2237
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files: []
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issn: 0268-1080
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journal: HEALTH POLICY AND PLANNING
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keywords: Health financing; pay-for-performance; inequality; Zimbabwe
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keywords-plus: CARE; QUALITY; PENALTIES; SERVICES; PAYMENT
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language: English
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month: APR 13
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number: '4'
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number-of-cited-references: '26'
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orcid-numbers: Borghi, Josephine/0000-0002-0482-5451
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pages: 429-439
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papis_id: 73b64692c3d9da9b29f33192e6fa8082
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ref: Kovacs2022whois
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times-cited: '0'
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title: Who is paid in pay-for-performance? Inequalities in the distribution of financial
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bonuses amongst health centres in Zimbabwe
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000757460500001
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usage-count-last-180-days: '1'
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usage-count-since-2013: '3'
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volume: '37'
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web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
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year: '2022'
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