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Incentives to change: effects of performance-based financing on health workers in Zambia

Overview of attention for article published in Human Resources for Health, February 2017
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (88th percentile)

Mentioned by

news
1 news outlet
policy
1 policy source
twitter
10 tweeters

Citations

dimensions_citation
57 Dimensions

Readers on

mendeley
301 Mendeley
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Title
Incentives to change: effects of performance-based financing on health workers in Zambia
Published in
Human Resources for Health, February 2017
DOI 10.1186/s12960-017-0179-2
Pubmed ID
Authors

Gordon C. Shen, Ha Thi Hong Nguyen, Ashis Das, Nkenda Sachingongu, Collins Chansa, Jumana Qamruddin, Jed Friedman

Abstract

Performance-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. Mixed 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. Econometric 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. In 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.

Twitter Demographics

The data shown below were collected from the profiles of 10 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 301 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 301 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 86 29%
Researcher 30 10%
Student > Ph. D. Student 30 10%
Student > Bachelor 19 6%
Student > Doctoral Student 16 5%
Other 46 15%
Unknown 74 25%
Readers by discipline Count As %
Medicine and Dentistry 56 19%
Nursing and Health Professions 44 15%
Social Sciences 26 9%
Business, Management and Accounting 24 8%
Economics, Econometrics and Finance 24 8%
Other 46 15%
Unknown 81 27%

Attention Score in Context

This research output has an Altmetric Attention Score of 19. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 May 2021.
All research outputs
#1,516,927
of 21,148,463 outputs
Outputs from Human Resources for Health
#159
of 1,088 outputs
Outputs of similar age
#32,100
of 276,994 outputs
Outputs of similar age from Human Resources for Health
#1
of 4 outputs
Altmetric has tracked 21,148,463 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,088 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.5. This one has done well, scoring higher than 85% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 276,994 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 88% of its contemporaries.
We're also able to compare this research output to 4 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them