Performance-based incentive can inject new life into public healthcare
A new patients’ lounge at the Machakos Level 5 Hospital. Incentive system for health care workers can improve services in public hospitals. PHOTO | FILE
Globally human resource managers, especially in the public sector in developing nations, are faced with poorly motivated employees.
In a bid to address this, several approaches have been used, with varying degrees of success. One such approach being attempted is incentive based payments.
The Business dictionary defines incentive pay as, “a monetary gift provided to an employee based on performance which is thought of as one way to entice the employee to continue delivering positive results.
Incentive pay may come in the form of a bonus, profit-sharing or commission”
An international NGO working in public healthcare in remote rural health facilities recently rolled out such a project in selected rural health facilities as a pilot. The thrust of their approach is that; the more clients you serve the better the incentive for the facility.
For many rural health facilities absenteeism by medical personnel is a frequent occurrence. The effect is that healthcare delivery and in return desired outcomes are low.
While such efforts are to be applauded, a few things need to be put into perspective. First, improving service delivery cannot be done without having a reliable measuring tool for the work done.
As a performance based project having reliable data on the work done is the first handicap to those rolling out such a project.
Some years ago while working in a remote health facility I had a firsthand experience on the handicaps the data capturing system poses. The facility, served by just one nurse, had no less than 21 registers or data capturing tools for recording various data sets.
The nurse saw the patient then was expected to record the data in one register, dispense medication and record it in another register then move on to the next patient. It took a long time for this to happen, all eating into the “patient care time”
As if not enough, this data had to be summarised at the end of the month in a monthly report. With many complaints as regards the quality of this data, a workgroup was formulated to see how this could be digitised.
Unfortunately years down the road little is to be seen of its outcome.
My recent visit several years down the road saw the same scenario still playing out: workload capturing in public health facilities is the same heavily manual, unreliable system fraught with fraud and errors.
All this is said in regards to this rewards approach. It is very easy to manipulate data in the current registers and indicate work has been done when it was not.
In one scenario a facility that was reliably verified as not having been opened for some time still generated data showing patients were attended to every day.
But technology offers a solution to such mishaps and is being used elsewhere. Amongst public health facilities requiring field visits, GPS enabled devices can confirm field and site visits by sending the time and geolocation of the officer at specific days and times as per their work schedule.
In dispensaries without tools that log in employees when they enter work and with a real time output monitoring capacity it is impossible to evaluate their productivity.
For such incentive based models therefore, the first step should be availing accurate measuring tools to health facilities.
“You can’t improve what you can’t measure accurately”
