The inescapable question of fairness in Pay-for-performance bonus distribution: a qualitative study of health workers’ experiences in Tanzania

by Victor Chimhutu, Nils Gunnar Songstad, Marit Tjomsland et al.
Globalization and Health, 2016 12:77 – Published: 25 November 2016

12 pp. 397 kB

During the last decade there has been a growing concern about the lack of results in the health sectors of many low income countries. Progress has been particularly slow in maternal- and child health. Prompted by the need to accelerate progress towards these health outcomes, pay-for- performance (P4P) schemes have been initiated in a number of countries. The results of this study suggest that the experience of unfairness in the way bonuses are distributed and administered at the health facility level undermines the legitimacy of the P4P scheme. More importantly, long term tensions and conflicts at the workplace may impact negatively on the quality of care which P4P was intended to improve.

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