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dc.contributor.authorBertone, Maria Paola
dc.contributor.authorLagarde, M.
dc.contributor.authorWitter, Sophie
dc.date.accessioned2018-06-29T22:02:28Z
dc.date.available2018-06-29T22:02:28Z
dc.date.issued2016-07-19
dc.identifierER4445
dc.identifier.citationBertone, M., Lagarde, M. & Witter, S. (2016) Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone, BMC Health Services Research, vol. 16, , ,
dc.identifier.issn1472-6963
dc.identifier.urihttp://doi.org/10.1186/s12913-016-1546-8
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/4445
dc.description.abstractmotivation and performance. However, the literature so far tends to look at PBF payments in isolation, without reference to the overall remuneration of health workers. Taking the case of Sierra Leone, where PBF was introduced in 2011, this study investigates the absolute and relative contribution of PBF to health workers' income and explores their views on PBF bonuses, in comparison to and interaction with other incomes. Methods: The study is based on a mixed-methods research consisting in a survey and an 8-week longitudinal logbook collecting data on the incomes of primary health workers (n = 266) and 39 in-depth interviews with a subsample of the same workers, carried out in three districts of Sierra Leone (Bo, Kenema and Moyamba). Results: Our results show that in this setting PBF contributes about 10 % of the total income of health workers. Despite this relatively low contribution, their views on the bonuses are positive, especially compared to the negative views on salary. We find that this is because PBF is seen as a complement, with less sense of entitlement compared to the official salary. Moreover, PBF has a specific role within the income utilization strategies enacted by health workers, as it provides extra money which can be used for emergencies or reinvested in income generating activities. However, implementation issues with the PBF scheme, such as delays in payment and difficulties in access, cause a series of problems that limit the motivational effects of the incentives. Overall, staff still favor salary increases over increases in PBF. Conclusions: The study confirms that the remuneration of health workers is complex and interrelated so that the different financial incentives cannot be examined independently from one. It also shows that the implementation of PBF schemes has an impact on the way it does or does not motivate health workers, and must be thoroughly researched in order to assess the impact of PBF.
dc.publisherBioMed Central
dc.relation.ispartofBMC Health Services Research
dc.titlePerformance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone
dc.typearticle
dcterms.accessRightspublic
dc.description.facultysch_iih
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dc.description.volume16
dc.identifier.doihttp://doi:10.1186/s12913-016-1546-8
dc.description.ispublishedpub
dc.description.eprintid4445
rioxxterms.typearticle
refterms.dateAccepted2016-06-12
refterms.dateFCA2016-08-23
refterms.dateFCD2016-08-23
qmu.authorWitter, Sophie
qmu.authorBertone, Maria Paola
qmu.centreInstitute for Global Health and Development
dc.description.statuspub
dc.description.number1


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