Looking a gift horse in the mouth: When PBF subsidies eventually demotivate, the case of Senegal

Introduction: Performance-based financing (PBF) was introduced in Senegal in 2012 as a pilot programme in two regions, and was rolled out to four other regions in 2014. PBF rewards performance through financial bonuses paid to staff and investment budgets for facilities, upon verification of quantitative indicators and a qualitative checklist. PBF incentives are hypothesized to play an important role in motivating of staff and improving the performance at facility level. However, more research is needed so as to better understand the way through which PBF incentives exactly brings positive workforce behavioural change.
Aim: Our study aims to explore the effects of distribution and utilization of performance premiums to staff and facilities on workforce behavioural change.
Methods: Our study rests on a mixed methods approach. Information was collected through semi-directive interviews with key informants and a review of administrative documents in a sample of facilities. The interview guide to be explored was established according to a short literature review on PBF effects on staff behavioural changes and a review of health structures’s expenditure records.
Results: Overall, staff positively welcomes financial rewards to individuals and facilities. However, PBF subsidies also appear to cause frustration to a certain extent. Staff criticizes the way performance payments are distributed to individuals and used at facility level. Dissatisfaction stems from irregularity of payment, feeling of unfairness in incentives distribution among staff, as well as due to low payment compared to increased workload to achieve performance objectives, perception of unjustified equipment purchase, often made unilaterally.
Conclusion: Our findings suggest that the positive link between staff and infrastructure bonuses and staff behavior change is not straightforward as they also represent an important source of dissatisfaction and frustration, and could lead to actually reduce the expected incentivizing effect of PBF. Therefore, further attention should be given to the distribution and utilization of the incentives as the incentives themselves to ensure a coherent incentive strategy.