Trial reportHuman resources for health2017
Incentives to change: effects of performance-based financing on health workers in Zambia.
Trial report in Human resources for health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Practical Implications of the Organizational Commitment Model in Healthcare: The Case of Nurses.Journal of nursing management · 2024Pooled it
- Paying for performance to improve the delivery of health interventions in low- and middle-income countries.The Cochrane database of systematic reviews · 2021Pooled it
- Payment methods for healthcare providers working in outpatient healthcare settings.The Cochrane database of systematic reviews · 2021Pooled it
- Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review.Human resources for health · 2021Pooled it
- How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review.BMC health services research · 2020Pooled it
- Structural, institutional and organizational factors associated with successful pay for performance programmes in improving quality of maternal and child health care in low and middle income countries: a systematic literature review.Journal of global health · 2018Pooled it
- In-kind incentives and health worker performance: Experimental evidence from El Salvador.Journal of health economics · 2020Trial
- A pilot study of a novel, incentivised mHealth technology to monitor the vaccine supply chain in rural Zambia.The Pan African medical journal · 2019Trial
- Financial autonomy of facilities providing primary care services in low- and middle-income countries: assessing the evidence to inform the development of a typology and conceptual framework.BMC health services research · 2025Article
- Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it's generalisability across settings.SSM - health systems · 2025Article
- Performance-based payments and intrinsic motivation among primary healthcare workers in China: a cross-sectional survey.BMJ open · 2025Article
- Identifying the active ingredients in payment for performance programmes using system dynamics modelling.SSM - health systems · 2025Article
- Addressing skilled birth attendants' needs of primary healthcare facilities in Nigeria using the human resources for health solutions model.Discover health systems · 2025Review
- Leveraging local health system resources to address quality healthcare gaps in sub-Saharan African: lessons from the SafeCare quality improvement programme in Ghana.BMC health services research · 2024Article
- Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.PloS one · 2024Article
- How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones.BMC research notes · 2023Article
- Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay.BMC health services research · 2023Article
- Exploring the roles of players in strategic purchasing for healthcare in Africa-a scoping review.Health policy and planning · 2023Article
- Effects of performance based financing on facility autonomy and accountability: Evidence from Zambia.Health policy OPEN · 2022Article
- Reviewing the evidence on health financing for effective coverage: do financial incentives work?BMJ global health · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPerformance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before-after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group.
methodsMixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program.
resultsEconometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity.
conclusionsIn Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction.
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