The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon

Performance-Based Financing (PBF) has been implemented in many countries to improve healthcare access, quality, and outcomes while ensuring the efficient and equitable allocation of resources within the healthcare system. However, little effort has been made to assess its impact. This study evaluates the impact of the PBF project on health workers' performance and healthcare quality in Mezam Division, North West region of Cameroon, between 2012 and 2022. Specifically, the study aims to understand health workers' perceptions of the PBF project, analyze the effect of PBF on health workers' output, and examine the impact of PBF on healthcare quality. A structured questionnaire was used to generate panel data among healthcare workers in six beneficiary health districts in the study site. The perception scores were estimated based on the Net Promoter Score (NPS) methodology, and variability was tested using Analysis of Variance (ANOVA). Health workers' output and performance indicators were analyzed using the chi-square test, assessing the relation between PBF introduction and changes in health workers' output, while healthcare quality metrics were analyzed using the Mann-Whitney U test to compare healthcare quality before and after PBF implementation. The results showed that health workers' perceptions varied but were generally positive, with a Net Promoter Score (NPS) of approximately 48.25. PBF significantly boosted health workers' output (p = 0.002) and healthcare quality (p < 0.05). We concluded that the PBF project in the Mezam Division had positive effects on workers’ output and the quality of healthcare delivered. Given the positive impacts, the study recommends scaling up PBF initiatives in Cameroon and other African countries with precarious health systems. Our study demonstrates the relevance of impact assessments in providing evidence for making informed decisions on efficient resource allocation in the health sector.