Assessment of Government Bonuses and Healthcare Performance in Southwestern Uganda

In Southwestern Uganda, a government performance bonus scheme in 2018 aimed to enhance government health centers. Healthcare system in Uganda suffers from entrenched issues, including inequalities in services and resource limitations. While financial incentives are universally recognized for enhancing healthcare performance, their specific impact in Southwestern Uganda is poorly understood. The study evaluated the effect of the bonus program on health center performance, quantified overall improvement, sustained improvements, and positive outcomes by facility type and district. Using a retrospective study design, the research compared government and nongovernment nonprofit health centers' administrative data from 2017 to 2022. Quantitative analysis, predominantly descriptive statistics, compared trends in the health service utilization indicators like ANC attendance, immunization coverage, institutional delivery, and HIV care. Results showed considerable improvement. First ANC visits increased from 184,310 in 2017 to 196,687 in 2022, and first trimester ANC attendance in the early trimester increased from 43,864 to 79,302. Institutional delivery also increased considerably from 127,048 to 169,019. There were also improvements in HIV control with increased infant PCR tests and viral suppression among ART clients. IPT3 uptake also increased from 124,642 to 127,419. Measles-rubella immunization, while generally improved, had fluctuations. In contrast, new tuberculosis cases increased from 4,897 to 8,954. The study suggested the potential for an association between bonuses and performance improvement in Ankole Region, whereas Kigezi Region experienced more muted performance, with suggestions of other influences at work. The positive trends are in line with the potential of performance-based incentives in resource-limited settings. The rise in TB cases and immunization fluctuation must be examined more closely. The descriptive design prevents firm attribution to the bonus system in isolation. The study suggests that government incentives can improve the performance of health centers, particularly in maternal and child health and HIV care in Southwestern Uganda.