Why performance-based contracting failed in Uganda--an "open-box" evaluation of a complex health system intervention

Social Science & Medicine
Freddie SsengoobaNatasha Palmer

Abstract

Performance-based contracting (PBC) is a tool that links rewards to attainment of measurable performance targets. Significant problems remain in the methods used to evaluate this tool. The primary focus of evaluations on the effects of PBC (black-box) and less attention to how these effects arise (open-box) generates suboptimal policy learning. A black-box impact evaluation of PBC pilot by the Development Research Group of the World Bank (DRG) and the Ministry of Health (MOH) concluded that PBC was ineffective. This paper reports a theory-based case study intended to clarify how and why PBC failed to achieve its objectives. To explain the observed PBC implementation and responses of participants, this case study employed two related theories i.e. complex adaptive system and expectancy theory respectively. A prospective study trailed the implementation of PBC (2003-2006) while collecting experiences of participants at district and hospital levels. Significant problems were encountered in the implementation of PBC that reflected its inadequate design. As problems were encountered, hasty adaptations resulted in a de facto intervention distinct from the one implied at the design stage. For example, inadequate time was allowed for t...Continue Reading

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Citations

May 2, 2014·Evaluation and Program Planning·Mat Walton
Apr 18, 2014·Health Research Policy and Systems·Kabir SheikhLucy Gilson
May 27, 2015·Health Policy and Planning·Rapeepong SuphanchaimatAnne Mills
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