@article{fdi:010080939,
  title = {{D}oes the gap between health workers' expectations and the realities of implementing a performance-based financing project in {M}ali create frustration ?},
  author = {{Z}itti, {T}. and {F}illol, {A}mandine and {L}ohmann, {J}. and {C}oulibaly, {A}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {P}erformance-{B}ased {F}inancing ({PBF}), an innovative health financing initiative, was recently implemented in {M}ali. {PBF} aims to improve quality of care by motivating health workers. {T}he purpose of this research was to identify and understand how health workers' expectations related to their experiences of the first cycle of payment of {PBF} subsidies, and how this experience affected their motivation and sentiments towards the intervention. {W}e pose the research question, "how does the process of {PBF} subsidies impact the motivation of health workers in {M}ali?" {M}ethods {W}e adopted a qualitative approach using multiple case studies. {W}e chose three district hospitals ({DH} 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the {K}oulikoro region. {O}ur cases correspond to the three {DH}s. {W}e followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each {DH}. {W}e analyzed data in a mixed deductive and inductive manner. {R}esults {T}he results show that the {PBF} subsidies led to health workers feeling more motivated to perform their tasks overall. {B}eyond financial motivation, this was primarily due to {PBF} allowing them to work more efficiently. {H}owever, respondents perceived a discrepancy between the efforts made and the subsidies received. {T}he fact that their expectations were not met led to a sense of frustration and disappointment. {S}imilarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. {T}he results show that frustrations can build up in the early days of the intervention. {C}onclusion {T}he {PBF} implementation in {M}ali left health workers frustrated. {T}he short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. {T}his underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.},
  keywords = {{M}otivation of health workers ; {P}erformance-based financing ; {D}istrict hospital ; expectations ; {F}rustration ; {M}ali ; {MALI}},
  booktitle = {},
  journal = {{G}lobal {H}ealth {R}esearch and {P}olicy},
  volume = {6},
  numero = {1},
  pages = {5 [10 p.]},
  year = {2021},
  DOI = {10.1186/s41256-021-00189-0},
  URL = {https://www.documentation.ird.fr/hor/fdi:010080939},
}