Does the gap between health workers’ expectations and the realities of implementing a performance-based financing project in Mali create frustration?

Abstract Background Performance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating workers. The purpose this research identify and understand how workers’ expectations related their experiences the first cycle payment subsidies, experience affected motivation sentiments towards intervention. We pose question, “how does process subsidies impact workers Mali?” Methods adopted a qualitative approach using multiple case studies. chose three district hospitals (DH 1, 2 3) districts (district among ten Koulikoro region. Our cases correspond DHs. followed principle data source triangulation; we used 53 semi-directive interviews conducted with (to follow saturuation), field notes, documents relating distribution grids for each DH. analyzed mixed deductive inductive manner. Results results show that led feeling more motivated perform tasks overall. Beyond financial motivation, primarily due allowing them work efficiently. However, respondents perceived discrepancy between efforts made received. fact were not met sense frustration disappointment. Similarly, way which distributed lack transparency feelings unfairness vast majority respondents. frustrations can build up early days Conclusion implementation Mali left frustrated. short overall period did allow actors adjust initial motivational responses, neither positive nor negative. This underlines short-term interventions might just impact, but instil negative likely carry on into future.