Keywords
healthcare providers
performance-based financing
health zone
Democratic Republic of Congo
How to Cite
Abstract
Introduction
Performance-based financing is one mechanism for improving the motivation of healthcare providers. To date, there is limited evidence on its effects on the motivation of healthcare staff in the Kenge Health Zone five years after project implementation.
Purpose
This study aimed to describe the motivating factors among healthcare providers in the Kenge Health Zone, a beneficiary of performance-based financing (PBF).
Methods
A descriptive cross-sectional study was conducted from 6 to 26 March 2024 among 302 healthcare providers selected through proportional sampling. Using SPSS version 25 and a 22-item Likert-scale questionnaire with five response options coded from 1 to 5, internal consistency was assessed using Cronbach’s alpha coefficient (0.736). The level of motivation was determined by comparing each respondent’s mean score with the overall mean of the scale, allowing classification of providers according to motivation level.
Results
Satisfaction with hygiene conditions (61.9%) and management (80.8%) was high, whereas perceived salary satisfaction was low (37.4%). Approximately two-thirds of participants had not received recent continuing professional education. The mean motivation score was 3.76. Slightly more than half of the healthcare providers (57.3%) were classified as motivated. The proportion of motivated women was slightly higher than that of motivated men.
Conclusion
The performance-based financing programme appears to have a positive effect on certain aspects of healthcare worker motivation; however, challenges related to remuneration and professional development persist. Staff motivation remains a concern for health authorities and is influenced by multiple factors. Further studies incorporating a broader range of motivational determinants are recommended to enable large-scale evaluation.
References
Allam, Y., Habachi, M., & Tabit, Y. (2024). Théories motivationnelles de contenu et théories motivationnelles de processus. International Journal of Accounting, Finance, Auditing, Management and Economics, 5(5), 247–258. https://doi.org/10.5281/zenodo.11212381
Ataféi, L. M. (2014). Amélioration de la motivation au travail des professionnels de la santé, facteur clé de performance: Exemple du Centre hospitalier universitaire Sylvanus Olympio de Lomé (Togo) (Master’s thesis).
Cabinet du Président de la République. (2016). Loi n°16/013 du 15 juillet 2016 portant statut des agents de carrière des services publics de l’État. Journal officiel de la République démocratique du Congo (Numéro spécial).
CREDES. (2018). Projet de développement du système de santé : Rapport annuel 2018.
Democratic Republic of the Congo. (2020). Plan stratégique national pour la couverture santé universelle (pp. 1–69).
Diallo, B., Kaka, Z. Y., & Saigbu, F. D. (2023). Influence des conditions de travail sur la performance des professionnels de santé de l’hôpital de district de Ségou au Mali. Revue française d’économie et de gestion, 4(5), 528–548.
Henderson, L. N., & Tulloch, J. (2008). Incentives for retaining and motivating health workers in Pacific and Asian countries. Human Resources for Health, 6(1), Article 18. https://doi.org/10.1186/1478-4491-6-18
Jackson, M. (2012). Étude de l’effet du financement basé sur la performance sur la motivation du personnel de santé : Étude transversale à visée analytique effectuée à l’hôpital de district de Mobayi [Unpublished report]. Institut national de santé publique, Burundi.
Kalk, A., Paul, F. A., & Grabosch, E. (2010). Paying for performance in Rwanda: Does it pay off? Tropical Medicine & International Health, 15(2), 182–190. https://doi.org/10.1111/j.1365-3156.2009.02430.x
Lindner, J. R., & Lindner, N. (2024). Interpreting Likert-type, summated, unidimensional, and attitudinal scales: I neither agree nor disagree, Likert or not. Advancements in Agricultural Development, 5(2), 152–163. https://doi.org/10.37433/aad.v5i2.351
Nkwahata, R., Tabibi, B., Nsungu, E., & Buhendwa, E. (2023). Demotivation factors for providers in the Kenge health zone in the context of performance-based financing. Revue internationale des sciences de gestion, 368–393.
Organisation mondiale de la Santé. (2021). Lignes directrices de l’OMS pour la production, l’attraction, le recrutement et la fidélisation des agents de santé dans les zones rurales et reculées (1st ed.). World Health Organization.
Roussel, P. (2000). La motivation au travail : Concepts et théories. Les notes du LIRHE, 1, 1–20.
Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2
Thomas, W. (2016). Motivation au travail dans les institutions publiques et l’effet des facteurs culturels : Une illustration dans le contexte haïtien (Doctoral dissertation, Université des Antilles).
USAID, & Management Sciences for Health. (2011). Le manuel du financement basé sur la performance.
Witter, S., Zulfiqur, T., Javeed, S., Khan, A., & Bari, A. (2011). Paying health workers for performance in Battagram District, Pakistan. Human Resources for Health, 9, Article 23. https://doi.org/10.1186/1478-4491-9-23
Zedini, C., Ben Cheikh, A., Limam, M., Henrichi, Y., Mellouli, M., El Ghardallou, M., Mtiraoui, A., & Ajmi, T. (2016). Les facteurs de motivation au travail chez les cadres paramédicaux dans un hôpital tunisien. Santé publique, 28(5), 613–622. https://doi.org/10.3917/spub.165.0613
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.