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Evaluative Ethnography is useful for Understanding the Impact Pathways of Performance‐Based Incentives on Health Worker Motivation
Author(s) -
Schuster Roseanne,
Sousa Octávio,
Reme AnneKathe,
Pinault Delphine,
Young Sera
Publication year - 2015
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.29.1_supplement.741.10
Subject(s) - formative assessment , incentive , ethnography , participant observation , community health , intervention (counseling) , qualitative research , psychology , nursing , public relations , medicine , sociology , public health , political science , pedagogy , social science , economics , anthropology , microeconomics
Performance‐based incentives (PBIs) have shown potential to improve the delivery of health and nutrition services to vulnerable populations. Strikingly, assessments of PBIs rarely incorporate qualitative approaches, making it difficult for policymakers to fully evaluate their utility. We employed evaluative ethnography to assess the impact of a longitudinal‐control PBI intervention to improve prevention of vertical transmission of HIV service delivery in rural Mozambique. Evaluative ethnography is a structured and theory‐grounded approach to qualitative research. The motivation, opportunity, and ability framework and focused ethnographic methods characterized our evaluative ethnographic approach.Table 1. Utilization of focused ethnography and quantitative methods to assess impact of the performance‐based incentive intervention on delivery of prevention of vertical transmission of HIV (PVT) servicesMethod Participants Intervention Phase n Evaluative Ethnography Methodology Semi‐structured interviews Women accessing PVT services, their family members, community leaders, facility‐ and community‐based health workers Formative 67 Group discussions Facility‐ and community‐based health workers, district leaders Formative, on‐going implementation 100 Participant observation Facility‐ and community‐based health workers On‐going implementation 140 Semi‐structured interviews Facility‐ and community‐based health workers, district leaders Final evaluation 15Quantitative Assessment MethodologySurveys of health worker motivation Facility‐ and community‐based health workers Formative, on going implementation, final evaluation 147Participant observation and exit interviews revealed the major barriers to the intervention (e.g. obstructionist officials, resource constraints). This was critical to understanding the quantitative finding that the PBIs did not significantly affect health worker motivation or delivery of services within the 12‐month implementation period. Although PBIs did not impact service delivery, evaluative ethnography allowed us to identify the principal problem areas. Considering the challenging nature of nutrition and health interventions in low‐resource health systems, we demonstrate that evaluative ethnography can augment conventional quantitative assessments.