How does performance-based financing affect health workers' intrinsic motivation? A Self-Determination Theory-based mixed-methods study in Malawi

Social Science & Medicine
Julia LohmannManuela De Allegri

Abstract

"Intrinsic motivation crowding out", the erosion of high-quality, sustainable motivation through the introduction of financial incentives, is one of the most frequently discussed but yet little researched potential unfavorable consequence of Performance-based Financing (PBF). We used the opportunity of the introduction of PBF in Malawi to investigate whether and how PBF affected intrinsic motivation, using a mixed-methods research design theoretically grounded in Self-Determination Theory (SDT). The quantitative component served to estimate the impact of PBF on intrinsic motivation, relying on a controlled pre- and post-test design, with data collected from health workers in 23 intervention and 10 comparison facilities before (March/April 2013; n = 70) and approximately two years after (June/July 2015; n = 71) the start of the intervention. The qualitative component, relying on in-depth interviews with health workers in selected intervention facilities one (April 2014; n = 21) and two (September 2015; n = 20) years after the start of PBF, served to understand how PBF did or did not bring about change in intrinsic motivation. Specifically, it allowed us to examine how the various motivation-relevant elements and consequences of ...Continue Reading

Citations

Jul 15, 2020·The American Journal of Tropical Medicine and Hygiene·Micaela De la Puente-LeónRicardo Castillo-Neyra
Jan 20, 2021·Journal of Health Organization and Management·Elisabeth PaulValéry Ridde
Sep 9, 2020·Social Science & Medicine·Omar GalárragaJackie Hoare
Feb 4, 2021·Journal of Health Organization and Management·Mathieu SeppeyValéry Ridde
May 6, 2021·The Cochrane Database of Systematic Reviews·Karin DiaconuSophie Witter
Jul 31, 2021·BMJ Global Health·Tom Newton-LewisTata Chanturidze

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