The role of pay for performance in improving maternal and child health in Mkuranga district Tanzania

Abstract

Pay for performance programs are one of the few health policy interventions intended to motivate health workers to improve their performance. This program was introduced in Tanzania with the aim of improving reproductive and child health services. The program was piloted in Mkuranga district in Tanzania since Jan 2011. Objective of the study is to evaluate the role of Pay for Performance on improving reproductive and child services. Methodology: Qualitative and quantitative cross sectional explorative evaluation study was conducted involving 31 health facilities in the program and 123 health care workers providing maternal and child health services. Data on performance and level of motivation of four indicators were collected before (retrospectively) and after P4P program. Mean level of motivation was calculated and compared before and after the program and tested for significance. Proportion of number of clients serviced was calculated before and after the program and compared for significance. Qualitative data was collected by conducting indepth interview conducted with health workers. Results: There was increase in number of ANC clients received IPT2 for hospital, health centre and dispensaries. The observed increase was statistically significant for health centre and dispensary (p<0.001). For Children received Measles vaccine there was no statistic significant increase for hospital (p=0.36). For dispensaries the number of clients received measles vaccine was greater than target population while for health centre there was statistically significant increase in number of clients attended (p<0.001). Facility deliveries findings show statistic significant increase in the number of clients attended at dispensaries and health centres (p<0.001). For hospital the number of deliveries exceeded the target population. PENTA 3 vaccine results show slight drop which was not statistically significant (p<0.001). Number of facility deliveries for health centres and dispensaries increased statistically significant (p<0.001). Conclusion and recommendation Pay for performance (P4P) program has positive effect on motivating health care workers to improve their performance. The policy of pay for performance should be adopted and rolled out to other regions of Tanzania. Moreover case control studies should be done