Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria

The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed t...

Full description

Bibliographic Details
Main Authors:	Mabuchi, Shunsuke, Sesan, Temilade, Bennett, Sara C.
Format:	Journal Article
Published:	Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine 2019
Subjects:	HEALTH FACILITIES HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SYSTEM REFORM HEALTH WORKERS MATERNAL HEALTH CHILD HEALTH PRIMARY HEALTH CARE COMMUNITY HEALTH
Online Access:	http://hdl.handle.net/10986/31370

id	okr-10986-31370
recordtype	oai_dc
spelling	okr-10986-313702021-05-25T10:54:37Z Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria Mabuchi, Shunsuke Sesan, Temilade Bennett, Sara C. HEALTH FACILITIES HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SYSTEM REFORM HEALTH WORKERS MATERNAL HEALTH CHILD HEALTH PRIMARY HEALTH CARE COMMUNITY HEALTH The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centers (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health center management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health center management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health center managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance. 2019-03-12T14:53:00Z 2019-03-12T14:53:00Z 2018-01 Journal Article Health Policy and Planning 1460-2237 http://hdl.handle.net/10986/31370 CC BY 4.0 http://creativecommons.org/licenses/by/4.0 World Bank Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine Publications & Research :: Journal Article Publications & Research Africa Nigeria
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
topic	HEALTH FACILITIES HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SYSTEM REFORM HEALTH WORKERS MATERNAL HEALTH CHILD HEALTH PRIMARY HEALTH CARE COMMUNITY HEALTH
spellingShingle	HEALTH FACILITIES HEALTH SECTOR REFORM HEALTH SERVICES HEALTH SYSTEM REFORM HEALTH WORKERS MATERNAL HEALTH CHILD HEALTH PRIMARY HEALTH CARE COMMUNITY HEALTH Mabuchi, Shunsuke Sesan, Temilade Bennett, Sara C. Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
geographic_facet	Africa Nigeria
description	The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centers (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health center management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health center management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health center managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance.
format	Journal Article
author	Mabuchi, Shunsuke Sesan, Temilade Bennett, Sara C.
author_facet	Mabuchi, Shunsuke Sesan, Temilade Bennett, Sara C.
author_sort	Mabuchi, Shunsuke
title	Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
title_short	Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
title_full	Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
title_fullStr	Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
title_full_unstemmed	Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria
title_sort	pathways to high and low performance : factors differentiating primary care facilities under performance-based financing in nigeria
publisher	Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine
publishDate	2019
url	http://hdl.handle.net/10986/31370
_version_	1764474173200007168

Pathways to High and Low Performance : Factors Differentiating Primary Care Facilities under Performance-Based Financing in Nigeria

Similar Items