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dc.contributor.authorBorghi, Josephine
dc.contributor.authorBinyaruka, Peter John
dc.contributor.authorMayumana, Iddy
dc.contributor.authorLange, Siri
dc.contributor.authorSomville, Vincent
dc.contributor.authorMæstad, Ottar
dc.date.accessioned2022-01-21T12:31:02Z
dc.date.available2022-01-21T12:31:02Z
dc.date.created2021-12-17T13:52:52Z
dc.date.issued2021
dc.identifier.issn2059-7908
dc.identifier.urihttps://hdl.handle.net/11250/2838711
dc.description.abstractBackground The success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.Methods We conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.Results Programme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.Conclusion Our study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.Data are available in a public, open access repository. The quantitative data for this paper are made available through Zenodo, DOI: 10.5281/zenodo.5636645, url: https://zenodo.org/record/5636646%23.YanUmtnMK3I.en_US
dc.language.isoengen_US
dc.publisherBMJen_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/deed.no*
dc.titleLong-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzaniaen_US
dc.typeJournal articleen_US
dc.typePeer revieweden_US
dc.description.versionpublishedVersionen_US
dc.rights.holderCopyright 2021 The Author(s)en_US
dc.source.articlenumbere006409en_US
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1
dc.identifier.doi10.1136/bmjgh-2021-006409
dc.identifier.cristin1969982
dc.source.journalBMJ Global Healthen_US
dc.relation.projectNorges forskningsråd: 234514en_US
dc.identifier.citationBMJ Global Health. 2021, 6 (12), e006409.en_US
dc.source.volume6en_US
dc.source.issue12en_US


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