BACKGROUND Tanzania is one of many low income countries committed to universal health coverage and Sustainable Development Goals. Despite these bold goals, there is growing concern that the country could be off-track in meeting these goals. This prompted the Government of Tanzania to look for ways to improve health outcomes in these goals and this led to the introduction of Payment for Performance (P4P) in the health sector. Since the inception of P4P in Tanzania a number of impact, cost-effective and process evaluations have been published with less attention being paid to the experiences of care in this context of P4P, which we argue is important for policy agenda setting. This study therefore explores these experiences from the perspectives of health workers, service users and community health governing committee members. METHODS A qualitative study design was used to elicit experiences of health workers, health service users and health governing committee members in Rufiji district of the Pwani region in Tanzania. The Payment for Performance pilot was introduced in Pwani region in 2011 and data presented in this article is based on this pilot. A total of 31 in-depth interviews with health workers and 9 focus group discussions with health service users and health governing committee members were conducted. Collected data was analysed through qualitative content analysis. RESULTS Study informants reported positive experiences with Payment for Performance and highlighted its potential in improving the availability, accessibility, acceptability and quality of care (AAAQ). However, the study found that persistent barriers for achieving AAAQ still exist in the health system of Tanzania and these contribute to negative experiences of care in the context of P4P. CONCLUSION Our findings suggest that there are a number of positive aspects of care that can be improved by Payment for Performance. However its targeted nature on specific services means that these improvements cannot be generalized at health facility level. Additionally, health workers can go as far as they can in improving health services but some factors that act as barriers as demonstrated in this study are out of their control even in the context of Payment for Performance. In this regard there is need to exercise caution when implementing such initiatives, despite seemingly positive targeted outcomes.

中文翻译：

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坦桑尼亚绩效付款（P4P）方面的护理经验。

背景技术坦桑尼亚是致力于全民健康覆盖和可持续发展目标的许多低收入国家之一。尽管有这些大胆的目标，但人们越来越担心该国可能无法实现这些目标。这促使坦桑尼亚政府寻求在这些目标中改善健康结果的方法，并导致在卫生部门引入绩效工资（P4P）。自从坦桑尼亚开始实施P4P以来，已经发表了许多影响，成本效益和过程评估，而在P4P的背景下，人们对护理的经验关注较少，我们认为这对政策议程的制定很重要。因此，本研究从卫生工作者，服务使用者和社区卫生管理委员会成员的角度探讨了这些经验。方法采用定性研究设计，从坦桑尼亚Pwani地区Rufiji区的卫生工作者，卫生服务使用者和卫生管理委员会成员中吸取经验。“绩效付费”试点于2011年在Pwani地区推出，本文提供的数据基于该试点。总共对卫生工作者进行了31次深度访谈，对卫生服务使用者和卫生管理委员会成员进行了9次焦点小组讨论。通过定性内容分析对收集的数据进行分析。结果研究受访者报告了绩效付款方面的积极经验，并强调了其在改善服务的可用性，可及性，可接受性和质量（AAAQ）方面的潜力。然而，研究发现，坦桑尼亚的卫生系统中仍然存在实现AAAQ的持续障碍，这些障碍助长了P4P背景下的负面护理经历。结论我们的研究结果表明，绩效付款可以改善护理的许多积极方面。但是，其针对特定服务的针对性意味着无法在医疗机构层面上对这些改进进行概括。此外，卫生工作者可以尽最大努力改善卫生服务，但是，即使在绩效工资的背景下，本研究中显示的某些障碍也无法控制。在这方面，尽管看似积极的目标成果，但在执行此类举措时仍需谨慎行事。