背景:基于结果的融资(RBF)正在成为许多非洲国家为卫生系统融资的新替代方案。在马里,开展了一个试点项目,通过为目标服务的绩效提供资金来改善卫生服务的需求和供应。没有研究探讨非洲此类项目的可持续性过程。本研究的目的是了解项目的可持续性过程并评估其可持续性水平。
方法:通过不同的决定因素来检查可持续性,阶段,级别和上下文。这些都是用定性访谈来辨别的,通过关键事件,利益相关者关于项目可持续性的想法。在不同利益相关者的参与下选择了数据收集站点,基于各种标准(农村/城市环境,参与程度,RBF参与者仍然出席,等。).然后在六个社区健康中心和两个转诊健康中心(从11/12/15至08/03/16)采访了49名利益攸关方,包括健康从业者,管理员,以及参与实施和概念化该计划的人(政府和非政府组织)。根据研究的概念框架,使用©QDAMiner软件进行主题分析。
结果:由于许多因素,该项目的结果表明可持续性水平较弱。虽然一些收益可以持续(例如。:对长期资源的投资,价值观和代码的高度兼容性,适应实现上下文的设计,等。)其他预期福利不能(例如。:投资结束,RBF周围缺乏共享的文化文物,失去不同的任务和程序,需要当地利益相关者对项目的更多所有权)。观察到缺乏可持续性规划,很少有关键事件与可持续发展阶段相关。
结论:虽然这个RBF项目旨在通过不同的机制(监督,投资,激励机制,等。),这些结果提出了以下问题:哪种类型的动机可以更稳定,以及当地利益相关者在项目中的位置;所有这些都是为了获得更持续和有效的结果。
BACKGROUND: Results-based financing (RBF) is emerging as a new alternative to finance health systems in many African countries. In Mali, a pilot project was conducted to improve demand and supply of health services through financing performance in targeted services. No study has explored the sustainability process of such a project in Africa. This study\'s objectives were to understand the project\'s sustainability process and to assess its level of sustainability.
METHODS: Sustainability was examined through its different determinants, phases, levels and contexts. These were explored using qualitative interviews to discern, via critical events, stakeholders\' ideas regarding the project\'s sustainability. Data collection sites were chosen with the participation of different stakeholders, based on a variety of criteria (rural/urban settings, level of participation, RBF participants still present, etc.). Forty-nine stakeholders were then interviewed in six community health centres and two referral health centres (from 11/12/15 to 08/03/16), including health practitioners, administrators, and those involved in implementing and conceptualizing the program (government and NGOs). A theme analysis was done with the software © QDA Miner according to the study\'s conceptual framework.
RESULTS: The results of this project show a weak level of sustainability due to many factors. While some gains could be sustained (ex.: investments in long-term resources, high compatibility of values and codes, adapted design to the implementations contexts, etc.) other intended benefits could not (ex.: end of investments, lack of shared cultural artefacts around RBF, loss of different tasks and procedures, need of more ownership of the project by the local stakeholders). A lack of sustainability planning was observed, and few critical events were associated to phases of sustainability.
CONCLUSIONS: While this RBF project aimed at increasing health agents\' motivation through different mechanisms (supervision, investments, incentives, etc.), these results raise questions on what types of motivation could be more stable and what could be the place of local stakeholders in the project; all this with the aim of more sustained and efficient results.