TY - JOUR AU - Gergen, Jessica AU - Rajkotia, Yogesh AU - Ravishankar, Nirmala PY - 2018/12/17 Y2 - 2024/03/29 TI - The good, the bad, and the disruptive of performance- based financing on the Mozambican health system: results from a process evaluation JF - Sociedade e Cultura JA - Soc. e Cult. VL - 21 IS - 2 SE - Dossiê DO - 10.5216/sec.v21i2.56312 UR - https://revistas.ufg.br/fcs/article/view/56312 SP - AB - <p>A significant debate is unfolding around whether performance based<br>financing (PBF) is a mechanism of achieving broader&nbsp;health systems transformation. This study aims to contribute&nbsp;to this dialogue by assessing how PBF fostered positive,&nbsp;perverse and disruptive effects on the health system in&nbsp;two provinces of Mozambique. The study used qualitative&nbsp;methods to collect data in 24 PBF health facilities from 60+&nbsp;health workers and facility administrators. PBF improved the&nbsp;facility’s work environment through improved local financial&nbsp;capacity and autonomy, resulting in greater planning. Health&nbsp;workers perceived incentives as a source of motivation,&nbsp;however the allocation of incentives among staff as unfair&nbsp;and lacking transparency. Major improvements in data quality<br>and completeness was observed in facility registers, verified&nbsp;quarterly. However, a heavier workload and enhanced focus on&nbsp;information systems were disruptive to time spent on clinical&nbsp;care. PBF remains a health systems strengthening intervention&nbsp;that results in targeted and program-driven changes that are&nbsp;not yet institutionalized or uniformly applied. Sustaining&nbsp;positive effects will requires greater focus on institutionalizing&nbsp;changes to governance, management structures, and financial&nbsp;autonomy, while enhancing inclusiveness of the&nbsp; demand-side.</p> ER -