Photo: European Commission

Poor service quality and insufficient coverage of critical life saving interventions prevail in many low-income countries. The underlying reasons are manifold and incompletely understood, but recent evidence suggest that the poor standard of health care is not only due to lack of capacity. Extensive absenteeism and a substantial gap between the clinical procedures health workers know they should follow, and what they actually do with patients (a “know-do gap”), indicate that lack of motivation among health care providers is a critical factor. Against this background, performance based financing is gaining momentum as an approach to boost motivation, strengthen health systems and improving health outcomes in low-income countries. This research project seeks to add to the limited evidence base regarding the implementation process, cost and long-term impact of performance based financing in the health sector.

The project will study the implementation and impact of performance based financing of health care in Tanzania. Over the course of five years (2015-2019) the project will:  a) Collect data over a long period to assess the enduring adaptation to, and impact of, performance incentives in health service provision. b) Measure non-intended (positive and negative) effects of incentivising professional work. Our long-term perspective, and particularly the fact that we collect data at several points of time, will enable us to say something about whether the potential dysfunctional effects aggravate or dissipate over time. c) We will integrate our study with an existing mortality surveillance system, which makes it possible to measure how performance based financing impact on health outcomes.

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