Pay for performance in Nigeria: the influence of context and implementation on results

Yewande Kofoworola Ogundeji, Cath Jackson, Trevor Sheldon, Olalekan Olubajo, Nnenna Ihebuzor

Research output: Contribution to journalArticlepeer-review

Abstract

Pay-for-performance (P4P) has recently been introduced in Nigeria to improve quality of health services. Its early results show significant variation between implementation sites. Literature suggests this might be explained by differences in design, context and implementation of the scheme. This study aimed to explore how context and implementation influence P4P in Nigeria. Semi-structured in-depth interviews with 36 health workers explored their views and experiences on how contextual and implementation factors influenced the impact of the P4P scheme. Data were analysed using the framework approach. Four themes captured the views and experiences of participants. Uncertainty of earning the incentive and inadequate infrastructure reduced health worker motivation and performance results; whilst adequate health worker understanding of the scheme and good managerial skills (health facility level) improved motivation and performance. Minimising delays in incentive payments, effective communication and improving the health workers understanding of the P4P scheme are likely to improve the outcomes of pay for performance programmes, independent of their design.

Original languageEnglish
Pages (from-to)955-963
Number of pages9
JournalHealth Policy and Planning
Volume31
Issue number8
Early online date1 Apr 2016
DOIs
Publication statusPublished - Oct 2016

Keywords

  • Behaviour change
  • Developing countries
  • Formative research
  • Health financing
  • Incentives
  • Primary health care
  • Attitude of Health Personnel
  • Humans
  • Interviews as Topic
  • Quality Improvement/economics
  • Developing Countries
  • Delivery of Health Care/economics
  • Qualitative Research
  • Health Personnel/economics
  • Nigeria
  • Reimbursement, Incentive/economics

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