Implementing the Agenda for Global Action on human resources for health : Analysis from an international tracking survey

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Removal of childbirth delivery fees : the impact on health workers in Ghana

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Start-stop funding, its causes and consequences : a case study of the delivery exemptions policy in Ghana

This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding—such as party politics and intersectoral haggling over resources—are unavoidable, but others, such as communication and management failures can and should be addressed.This work was undertaken as part of an international research programme— Initiative for Maternal Mortality Programme Assessment (IMMPACT), funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID

Rural Health Services in China: Their Relevance for Vietnam

Vietnam is the country which stands to learn the most by studying developments in health in rural areas of China. In terms of history, culture and recent political and economic reforms, it shares a great deal in common with China, but its reforms have lagged behind, giving it the chance to benefit from positive and negative trends emerging in its bigger neighbour. The Vietnamese will want to consider carefully such issues as the impact of current health financing systems in rural China, and the balance of gains and losses which have resulted from granting wide powers of autonomy to providers to raise funds and manage themselves

An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone.

The need for evidence-based practice calls for research focussing not only on the effectiveness of interventions and their translation into policies, but also on implementation processes and the factors influencing them, in particular for complex health system policies. In this paper, we use the lens of one of the health system's 'building blocks', human resources for health (HRH), to examine the implementation of official policies on HRH incentives and the emergence of informal practices in three districts of Sierra Leone. Our mixed-methods research draws mostly from 18 key informant interviews at district level. Data are organised using a political economy framework which focuses on the dynamic interactions between structure (context, historical legacies, institutions) and agency (actors, agendas, power relations) to show how these elements affect the HRH incentive practices in each district. It appears that the official policies are re-shaped both by implementation challenges and by informal practices emerging at local level as the result of the district-level dynamics and negotiations between District Health Management Teams (DHMTs) and nongovernmental organisations (NGOs). Emerging informal practices take the form of selective supervision, salary supplementations and per diems paid to health workers, and aim to ensure a better fit between the actors' agendas and the incentive package. Importantly, the negotiations which shape such practices are characterised by a substantial asymmetry of power between DHMTs and NGOs. In conclusion, our findings reveal the influence of NGOs on the HRH incentive package and highlight the need to empower DHMTs to limit the discrepancy between policies defined at central level and practices in the districts, and to reduce inequalities in health worker remuneration across districts. For Sierra Leone, these findings are now more relevant than ever as new players enter the stage at district level, as part of the Ebola response and post-Ebola reconstruction

How to get research into practice : first get practice into research

sch_iih2007 Jpub2738pub

Learning health systems in low-income and middle-income countries: exploring evidence and expert insights.

From Europe PMC via Jisc Publications RouterHistory: ppub 2022-09-01Publication status: PublishedIntroductionLearning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings.MethodsWe adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge.ResultsThe findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels.We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with 'best fit' solutions.ConclusionHealth systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge

Pay for performance for strengthening delivery of sexual and reproductive health services in low- and middle-income countries Evidence synthesis paper

This paper was commissioned by the World Bank as a document to support government decisionmaking in the East Asia Region. Many thanks to Seemeen Saadat for her assistance with the literature search and summary tables. The paper has also benefited from guidance from Aparnaa Somanathan. Any errors however are the responsibility of the author's.Washington, D.C.Background This paper aims to bring together the global evidence on paying providers for performance (P4P), its impact on the delivery of sexual and reproductive health services, and the conditions under which it may have been effective. It is based on a literature review carried out in November-December 2011, with some updating in 2013. It synthesises evidence from policies and projects which have been documented and published to date. The sources include the few available published impact evaluations as well as the more extensive internal reports focussing on early implementation experiences. It focuses on supply-side measures, and complements a recent report on demand-side financing for SHR services in low and middle-income countries.sch_iihAmara, M. 2011, Designing of Sierra Leone simple performance based financing Scheme (PBF). Presentation to PBF workshop, Bujumbura, February 2011. Basinga, P., Gertler, P., Binagwaho, A., Soucat, A., Sturdy, J., & Vermeersch, C. 2010, Paying primary health centres for performance in Rwanda, Policy research working paper 5190; Washington, D.C.: World Bank. Basinga, P., Gertler, P., Binagwaho, A., Soucat, A., Sturdy, J., & Vermeersch, C. 2011, Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation, The Lancet, vol. 377, pp. 1421-1428. Bloom, E., Bhushan, I., Clingingsmith, D., Hong, R., King, E., Loevinsohn, B., Kremer, M., Schwartz, J.B. 2007, Contracting for Health: Evidence from Cambodia http://www.brookings.edu/views/papers/kremer/20060720cambodia.pdf Brennan, R.J., Rogers, D., Sarcar, S., Vergeer, P. 2010, Identifying Indicators for Performance Based Contracting (PBC) is Key: The Case of Liberia. Results Based Financing for Health, Washington D.C: World Bank. Brenzel, L. 2009, Taking Stock: World Bank Experience with Results-Based Financing (RBF) in Health; World Bank: Washington D.C. Brenzel, L. and Naimoli, J., 2009, Health RBF in Practice: ten institutional challenges. Washington, D.C.: World Bank: Technical Brief. Busogoro, JF. , Beith A. 2010, Pay-for-performance for Improved Health in Burundi. Bethesda, Maryland: HealthSystems 202/20 project, Abt Associates Inc. Canavan, A. & Swai, G. 2008, Payment for Performance (P4P) Evaluation: Tanzania Country Report for Cordaid. Amsterdam: KIT. Canavan, A., Toonen, J., Elovainio, R. 2008, Performance Based Financing: An International Review of the Literature, KIT Development Policy & Practice, Amsterdam: KIT. Chee, G., His N., Carlson K., Chankova S., Taylor P. 2007, Evaluation of the first five years of GAVI immunisation services support funding. Prepared for the GAVI Alliance. Behtesda, MD: Abt Associates Inc. Christianson, J., Leatherman, S., & Sutherland, K. 2007, Financial incentives, healthcare providers and quality improvements: a review of the evidence, The Health Foundation, London. Custers, T., Hurley, J. Klazinga, N. and Brown, A. 2008, Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance, BMC Health Services Research, vol. 8: 66. Dagur, V., Senauer, K., Switlick-Prose K. July 2010, Paying for Performance: The Janani Suraksha Yojana Program in India. Bethesda, Maryland: Health Systems 20/20 project, Abt Associates Inc. Deci, E., Koestner, R. and Ryan, M. 1999, A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation, Psychological Bulletin, Vol. 125, No. 6, 627-6. 38 Pay for performance for sexual and reproductive health care in low and middle-income countries, Witter, 2013 De Walque, D., Gertler, P., Arredondo, S., Kwan, A., Vermeersch, C, Bizimana, J., Binagwaho, A., Condo, J. 2013, Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda. Washington, DC: World Bank. Policy Research Working Paper 6364. Eichler R. 2006, Can Pay for Performance Increase Utilization by the Poor and Improve the Quality of Health Services? Discussion paper for the first meeting of the Working Group on Performance- Based Incentives. Washington D.C.: Center for Global Development. 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Emmert, M., Eijkenaar, F., Kemter, H., Esslinger, A., Schoffski, O. 2012, Economic evaluation of payfor- performance in health care: a systematic review. European Journal of Health Economics, vol, 13; pp. 755-767. Ensor, T., Kilby, A., Myers, J., Hay, R., 2009, Management reforms and performance in a London Teaching Hospital. Oxford: Oxford Policy Institute. Falisse, J-B., Meessen, B., Ndayishimiye, J., Bossuyt, M. 2012, Community participation and voice mechanisms under performance-based financing schemes in Burundi. Tropical Medicine and International Health, vol. 17, no 5, pp 674-682. Fox, S., Witter, S., Wylde, E., Mafuta, E., Lievens, T. 2013, Paying for performance in a fragmented, fragile state: reflections from Katanga Province, Democratic Republic of Congo. Health Policy and Planning. doi: 10.1093/heapol/czs138. Furth R. 2006. Zambia Pilot Study of Performance-based Incentives. Operations Research Results. 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Harris, M. 2011, Brazil's Family Health Programme: A cost effective success that higher income countries could learn from, Editorial, British Medical Journal 341:c4945. Hawkins, L., 2011, Synthesis assessment of medium-term issues and options for supply and demandside initiatives for improving quality and access to health services, supported under HSP 2. Draft paper for Cambodia mid-term review. Hecht, R., Batson, A., Brenzel, L. 2004, Making Health Care Accountable: The New Focus on Performance Based Funding of Health Services in Developing Countries, in Health and Development: Why Investing in Health is Critical for Achieving Economic Development Goals, Finance & development, Washington DC: International Monetary Fund. Jack, W., 2003, Contracting for Health Services: An evaluation of recent reforms in Nicaragua. Health Policy and Planning; 18(2): 195-204. Johannes, L., Mullen, P., Okwero, P., Schneidman, M. 2008, Performance based financing in health: The experience of three projects in Africa, Note No. 19, OBApproaches. Washington D.C.: Global Partnership on Output-based Aid/The World Bank. Kalk, A., Paul, F., Grabosch, E. 2010, Paying for Performance in Rwanda: Does it Pay Off?, Tropical Medicine and International Health, 15(2): 182-190. Lim, S., Dandona, L., Hoisington, J., James, S., Hogan, M., Gakidou, E. 2010, India's Janani Suraksha Yojana, A Conditional Cash Transfer Programme to Increase Births in Health Facilities: An Impact Evaluation. The Lancet, 375(9730): 2009-2023. Lu C., Michaud C., Gakidou E., Khan K., Murray C. 2006, Effect of the Global Alliance for Vaccines and Immunisation on diphtheria, tetanus, and pertussis vaccine coverage: an independent assessment. Lancet; 368(9541):1088-1095. Macq, J., Chiem J-C. 2011, Looking at the effects of performance-based financing through a complex adaptive systems lens. WHO Bulletin; vol. 89(9): pp. 699-700. Macro International, 2009, The Five-Year Evaluation of the Global Fund to Fight AIDS, Tuberculosis, and Malaria Synthesis of Study Areas 1, 2 and 3. Washington D.C.: Macro International. Maestad, O. 2007, Rewarding Safe Motherhood: How can Performance-Based Funding Reduce Maternal and Newborn Mortality in Tanzania? Bergen: Chr. Michelsen Institute. Maynard, A. & Bloor, K. 2010, Will financial incentives and penalties improve hospital care?, British Medical Journal, vol. 340, no. 88. Marquand, D., 2004, Decline of the Public: the Hollowing Out of Citizenship. Cambridge: Polity Press. Meessen, B., Musango, L., Kashala, JPI., Lemlin, J. 2006, Reviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda, Tropical Medicine and International Health, 11(8): 1303-1317. Meessen, B., Soucat, A., & Sekabaraga, C. 2011, Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform? Bulletin of the World Health Organization, vol. 89, no. 153, p. 156. 40 Pay for performance for sexual and reproductive health care in low and middle-income countries, Witter, 2013 Meuwissen L., Gorter A., Kester A., Knottnerus J. 2006, Can a Comprehensive Voucher Programme Prompt Changes in Doctors' Knowledge, Attitudes and Practices Related to Sexual and Reproductive Health Care for Adolescents? A case study from Latin America, Tropical Medicine and International Health, 11(6):889-98. Morgan, L. 2010, Some days are better than others: Lessons Learnt from Uganda's First Results Based Financing Pilot, RBF Feature story, Washington D.C.: The World Bank. Morgan, L. 2010a, A contract too far? Will performance-based contracting (really) work in Southern Sudan, RBF Feature Story, Washington, D.C.: The World Bank. Morgan, L. 2011, When the Hustle Gets Rough: Making Performance-Based Contracting Work in Liberia, RBF Feature Story, Washington DC: The World Bank. Morgan, L., Beith, A., Eichler, R., 2011, Performance-Based Incentives for Maternal Health: Taking Stock of Current Programs and Future Potentials. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc. Morgan, L., Eichler, R. 2009, Pay for Performance in Tanzania. Bethesda. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc. Myers, J., 2008, Public Service Motivation' and performance incentives: a literature review. Oxford: Oxford Policy Institute. Musgrove, P. 2011, Rewards for good performance or results: a short glossary. Washington, D.C.: World Bank. Naimoli, J. and Vergeer, P. (eds.) 2010, A Series of Snapshots of Experiences in Verifying Performance Linked to Financial Incentives for Results-Based Financing (RBF) Programs from Selected Countries; Results based financing for health verification at a glance. Washington D.C.: The World Bank. OECD, 2005, Performance-related Pay Policies for Government Employees. Paris: OECD. Opwora, A., Kabare, M., Molyneux, S., & Goodman, C., 2009, Financing Kenyan health centres and dispensaries: exploring the implementation and effects of Direct Facility Funding in Kenya. Nairobi: CREHS Policy Brief. Oxman A., Lavis J., Fretheim A. 2007, Use of evidence in WHO recommendations, Lancet, Vol. 369, pp. 1883-9. Oxman A., Fretheim A. 2008, An overview of research on the effects of results-based financing. Report No. 16. Oslo: Norwegian Knowledge Centre for the Health Services. Peabody, J., Shimkhada, R., Quimbo, S., Florentino, J., Bacate, M., McCulloch, C., & Solon, O. 2011, Financial incentives and measurement improved physicians' quality of care In the Philippines, Health Affairs, vol. 30, no. 4, pp. 773-781. Pearson, M., 2010, Results based aid and results based financing: What are they? Have they delivered results? London: HLSP Institute. Perrin, B. 2013, Evaluation of payment by results: current approaches, future needs. Report of a study commissioned for the Department for International Development, London. http://www.oecd.org/derec/unitedkingdom/DFID_PaymentbyResults.pdf Petersen, L., Woodard, L., Urech, T., Daw, C., Sookanan, S. 2006, Does Pay-for-Performance Improve the Quality of Health Care? Annals of Internal Medicine, 145:265-272. 41 Pay for performance for sexual and reproductive health care in low and middle-income countries, Witter, 2013 Powell-Jackson, T., Neupane, B., Tiwari, S., Morrison, J., & Costello, A. 2008, Final report of the evaluation of the Safe Delivery Incentive Programme. London: DFID. Rowan, M. 2009, Performance-Based Disbursement: Innovations in FP Project. Delhi: Futures Group International. Savedoff, W. 2010, Basic economics of results-based financing in health. Bath, Maine: Social Insight. Sekabaraga, C., Soucat, A., Diop, F., Martin, G. 2010, Innovative Financing for Health in Rwanda: A Report of Successful Reforms, in Yes Africa Can: success stories from a dynamic continent, Punam Chuhan-Pole, P. & Angwafo, M. (eds.); Washington D.C.: The World Bank. Sekabaraga, C., Diop, F., Soucat, A. 2011, Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda, Health Policy and Planning; 26 :ii52-ii62. Sheffler, R. 2010, Pay For Performance (P4P) programs in health services: what is the evidence? World Health Report 2010 Background Paper 31. Geneva : WHO. Soeters R. & Kimakuka C., 2008, Rsultats de l'Enqute Mnage, l'Enqute Qualit, et l'Enqute Infirmiers Titulaires. Pour le programme Achat de Performance dans les Zones de Sant du District Sanitaire Nord du Sud Kivu. The Hague: CORDAID. Soeters R. & Kimakuka C., 2009, Rapport tude d'valuation, Achat de Performance Burundi. The Hague: CORDAID. Soeters, R., Musango, L., & Meessen, B. 2005, Comparison of two output based schemes in Butare and Cyangugu provinces with two control provinces in Rwanda. Kigali: GBPOA, World Bank, and Ministry of Health Rwanda. Soeters, R., Peerenboom, PB., Mushagalusa, P., Kimanuka, C. 2011, Performance-Based Financing Experiment Improved Health Care in the Democratic Republic Of Congo, Health Affairs, 30:81518- 1527. Soeters R. 2013, PBF in Action: Theory and Instruments. Course Guide - Performance Based Financing (PBF). The Hague: CORDAID-SINA. Sondorp, E., Palmer, N., Strong, L. and Wali, A. 2009, Afghanistan: Paying NGOs for Performance in a Post-conflict Setting; Washington D.C., Center for Global Development. Ssengooba F., McPake B., Palmer N. 2012, Why performance-based contracting failed in Uganda: an open-box evaluation of a complex health system intervention. Social Science & Medicine; pp. 377- 83. Toonen, J., Canavan, A., Vergeer, P., & Elovainio, R. 2009, Performance Based Financing: a synthesis report. Amsterdam: KIT, in collaboration with Cordaid and WHO. Toonen, J. and Van der Wal, B. 2012, Results based financing in healthcare: developing an RBF approach for healthcare in different contexts: the cases of Mali and Ghana. Amsterdam: KIT. UNFPA, 2009, Concurrent Assessment of Janani Suraksha Yojana (JSY) in Selected States: Bihar, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh, New Delhi, India: United Nations Population Fund. USAID, 2010, Performance Based Incentives: Primer for USAID Missions, Washington D.C.: United States Agency for International Development. 42 Pay for performance for sexual and reproductive health care in low and middle-income countries, Witter, 2013 Vergeer, P. & Collins, C. 2008, Payment for Performance (P4P) Evaluation: Zambia Country Report, Amsterdam: Cordaid/KIT. Vermeersch C., Rothenbuhler E., Sturdy J. 2012, Impact evaluation toolkit: measuring the impact of results-based financing on maternal and child health. Washington, D.C.: World Bank. Vinard, P., 2011, Lesson learning and documenting health system development and the role of performance based financing experience in Burundi, DR Congo, Rwanda and South Sudan. Amsterdam: HealthNet TPO/ALTER. WHO, 2010, Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. Geneva: World Health Organisation. WHO, 2011, Performance based grants for reproductive health in the Philippines. Policy Brief, Department of Reproductive Health and Research; Manilla, Philippines. Manilla: World Health Organization and ATENEO de Manilla University Graduate School of Business. William, J. 2003, Contracting for Health Services: An evaluation of recent reforms in Nicaragua, Health Policy and Planning, 18(2): 195-204. Witter, S. 2013, Demand-side financing for strengthening delivery of sexual and reproductive health services: evidence synthesis paper. Washington, D.C.: World Bank. Witter, S., Toonen, J. Meessen, B., Kagubare, J., Fritsche, G. and Vaughan, K. 2013, Performancebased financing as a health system reform- mapping the key dimensions for monitoring and evaluation. BMC Health Services Research, 13:36. Witter, S., Fretheim, A., Kessy, F., & Lindahl, A. 2012, Paying for performance to improve the delivery of health interventions in low and middle-income countries, Cochrane Library, issue 2. Witter, S., Khadka, S., Nath, H., & Tiwari, S. 2011b, The national free delivery policy in Nepal: early evidence of its effects on health facilities, Health Policy and Planning, vol. 26, p. ii84-ii91. Witter, S., Zulfikar, T., Javeed, S., Khan, A., & Bari, A. 2011a, Paying health workers for performance in Battagram district, Pakistan, Human Resources for Health, vol. 9, no. 23. World Bank, 2007, Performance based contracting to improve health services in post-conflict situations: DRC. Washington D.C.: The World Bank. Zeng, W., Cros, M., Wright, K., Shepard, D. 2012, Impact of performance-based financing on primary health care services in Haiti, Health Policy and Planning, vol. 10.pub3283pu

Mapping user fees for health care in high-mortality countries - evidence from a recent survey

In recent years several countries have introduced reforms to user fees; a growing number of countries are also introducing basic health care free at the point of use. In many cases, the focus has been on making health care more accessible for priority groups, particularly pregnant women and young children. However, despite the high interest in user fee removal, there are many information gaps on the current status of user fees in low-income countries, particularly for those interested in carrying out international comparisons. This paper presents a useful snapshot of some patterns in this changing area of health financing from 49 countries in Africa and Asia.sch_iihpub3026pu

Strategies for Maternal Mortality Reduction in Senegal: Evaluation of the Free Delivery Policy and Delegation of Tasks

For further information, visit Immpact at www.immpact-international.org.Aberdeen, Scotlandsch_iihpub3029pu