article · International Journal of Health Economics and Policy
Performance-based financing seeks to enhance healthcare access, quality, and resource distribution, yet evidence of its long-term impact remains limited. An observational panel study conducted between 2012 and 2022 examined the influence of this financing mechanism across six beneficiary health districts in the Mezam Division, located in the North West region of Cameroon. Researchers gathered panel data from healthcare staff using structured questionnaires, evaluating staff attitudes via the Net Promoter Score framework, alongside changes in output and service standards. Healthcare workers demonstrated a generally favourable view of the programme, yielding a Net Promoter Score of roughly 48.25. The implementation of performance-based financing led to statistically significant gains in staff productivity and demonstrated measurable improvements in the quality of delivered healthcare services, providing support for the wider adoption of such incentive models in similar healthcare environments.
Securing high-quality healthcare and motivating staff are major challenges in under-resourced regions. Demonstrating that performance-based funding directly enhances worker output and patient care standards provides clear evidence for policymakers and international donors seeking cost-effective mechanisms to strengthen fragile healthcare delivery systems.
This applied research provides validated operational insights for public health authorities, development agencies, and healthcare management organisations designing financing interventions. The evidence directly informs policy implementation and health system programmes, representing an applied and tested approach ready for regional scaling rather than a commercial product.
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Performance-Based Financing (PBF) has been implemented in many countries to improve healthcare access, quality, and outcomes while ensuring the efficient and equitable allocation of resources within the healthcare system. However, little effort has been made to assess its impact. This study evaluates the impact of the PBF project on health workers' performance and healthcare quality in Mezam Division, North West region of Cameroon, between 2012 and 2022. Specifically, the study aims to understand health workers' perceptions of the PBF project, analyze the effect of PBF on health workers' output, and examine the impact of PBF on healthcare quality. A structured questionnaire was used to generate panel data among healthcare workers in six beneficiary health districts in the study site. The perception scores were estimated based on the Net Promoter Score (NPS) methodology, and variability was tested using Analysis of Variance (ANOVA). Health workers' output and performance indicators were analyzed using the chi-square test, assessing the relation between PBF introduction and changes in health workers' output, while healthcare quality metrics were analyzed using the Mann-Whitney U test to compare healthcare quality before and after PBF implementation. The results showed that health workers' perceptions varied but were generally positive, with a Net Promoter Score (NPS) of approximately 48.25. PBF significantly boosted health workers' output (p = 0.002) and healthcare quality (p < 0.05). We concluded that the PBF project in the Mezam Division had positive effects on workers’ output and the quality of healthcare delivered. Given the positive impacts, the study recommends scaling up PBF initiatives in Cameroon and other African countries with precarious health systems. Our study demonstrates the relevance of impact assessments in providing evidence for making informed decisions on efficient resource allocation in the health sector.
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DOI: 10.11648/j.hep.20251002.13
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