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dc.contributor.authorChimhutu, Victor
dc.contributor.authorLindkvist, Ida
dc.contributor.authorLange, Siri
dc.description.abstractBackground: Despite limited evidence of its effectiveness, performance-based payments (P4P) are seen by leading policymakers as a potential solution to the slow progress in reaching Millennium Development Goal 5: improved maternal health. This paper offers insights into two of the aspects that are lacking in the current literature on P4P, namely what strategies health workers employ to reach set targets, and how the intervention plays out when implemented by local government as part of a national programme that does not receive donor funding. Methods: A total of 28 in-depth interviews (IDIs) with 25 individuals were conducted in Mvomero district over a period of 15 months in 2010 and 2011, both before and after P4P payments. Seven facilities, including six dispensaries and one health centre, were covered. Informants included 17 nurses, three clinical officers, two medical attendants, one lab technician and two district health administrators. Results: Health workers reported a number of strategies to increase the number of deliveries at their facility, including health education and cooperation with traditional health providers. The staff at all facilities also reported that they had told the women that they would be sanctioned if they gave birth at home, such as being fined or denied clinical cards and/or vaccinations for their babies. There is a great uncertainty in relation to the potential health impacts of the behavioural changes that have come with P4P, as the reported strategies may increase the numbers, but not necessarily the quality. Contrary to the design of the P4P programme, payments were not based on performance. We argue that this was due in part to a lack of resources within the District Administration, and in part as a result of egalitarian fairness principles. Conclusions: Our results suggest that particular attention should be paid to adverse effects when using external rewards for improved health outcomes, and secondly, that P4P may take on a different form when implemented by local implementers without the assistance of professional P4P specialists.en_US
dc.publisherBioMed Centraleng
dc.relation.ispartof<a href="" target="blank">Results-Based Financing (RBF) in the health sector of a low-income country. From agenda setting to implementation: The case of Tanzania</a>
dc.rightsAttribution CC BYeng
dc.subjectPayment for performanceeng
dc.subjectResults-based financingeng
dc.subjectHome birtheng
dc.subjectWorking conditionseng
dc.subjectPublic healtheng
dc.subjectReproductive healtheng
dc.subjectMaternal healtheng
dc.titleWhen incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania - a qualitative studyeng
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2014 Chimhutu et al.; licensee BioMed Central Ltd.
dc.rights.holderVictor Chimhutu et al.; licensee BioMed Central Ltd.eng
dc.source.journalBMC Health Services Research

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