Performance-Based Financing in the context of the ‘complex remuneration’ of Health Workers – Findings from a mixed-methods study in rural Sierra Leone
Presentation by ReBUILD affiliate researcher Maria Paola Bertone given at the International Health Economics Association Congress in Milan 15th July 2015.
This presentation is based on research to investigate the contribution of performance-based financing (PBF) bonuses to on the incomes of health workers (HWs) in rural Sierra Leone, to explore their views on motivation and performance payments, and to analyze the health workers’ perceptions on revenues and livelihoods with regard to PBF and the interaction with other incomes.
Overall, pay for ‘performance’ represents about 10% of the total income for primary HWs, seems to be well perceived by HWs, despite the implementation issues and the relative small amount compared to the overall income, and contributes to HWs’ livelihoods as ‘addition’ for family emergencies, subsistence, or re-investment. However, the PBF scheme’s design and implementation has an important impact on the ways it (de)motivates HWs. Remuneration is ‘complex’ and interrelated, as HWs enact compensating and coping strategies.
This has relevance for responses during the Ebola outbreak, and in post-Ebola health system strengthening.