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

Therence Nwana Dingana; Balgah Roland Azibo; Daniel Agwenig Ndisang; Stewart Ndutard Ngasa; Leo Cedric Fozeu Fosso

doi:doi:10.11648/j.hep.20251002.13

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

Therence Nwana Dingana^*

, Balgah Roland Azibo

, Daniel Agwenig Ndisang

, Stewart Ndutard Ngasa

, Leo Cedric Fozeu Fosso

Published in International Journal of Health Economics and Policy (Volume 10, Issue 2)

Received: 21 March 2025 Accepted: 31 March 2025 Published: 29 April 2025

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Abstract

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.

Published in	International Journal of Health Economics and Policy (Volume 10, Issue 2)
DOI	10.11648/j.hep.20251002.13
Page(s)	43-59
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Cameroon, Healthcare Quality, Impact Assessment, Northwest Region, Performance Based Financing, Workers Output

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Dingana, T. N., Azibo, B. R., Ndisang, D. A., Ngasa, S. N., Fosso, L. C. F. (2025). The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. International Journal of Health Economics and Policy, 10(2), 43-59. https://doi.org/10.11648/j.hep.20251002.13

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Dingana, T. N.; Azibo, B. R.; Ndisang, D. A.; Ngasa, S. N.; Fosso, L. C. F. The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. Int. J. Health Econ. Policy 2025, 10(2), 43-59. doi: 10.11648/j.hep.20251002.13

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Dingana TN, Azibo BR, Ndisang DA, Ngasa SN, Fosso LCF. The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. Int J Health Econ Policy. 2025;10(2):43-59. doi: 10.11648/j.hep.20251002.13

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@article{10.11648/j.hep.20251002.13,
  author = {Therence Nwana Dingana and Balgah Roland Azibo and Daniel Agwenig Ndisang and Stewart Ndutard Ngasa and Leo Cedric Fozeu Fosso},
  title = {The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon
},
  journal = {International Journal of Health Economics and Policy},
  volume = {10},
  number = {2},
  pages = {43-59},
  doi = {10.11648/j.hep.20251002.13},
  url = {https://doi.org/10.11648/j.hep.20251002.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20251002.13},
  abstract = {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.
},
 year = {2025}
}

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TY  - JOUR
T1  - The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon

AU  - Therence Nwana Dingana
AU  - Balgah Roland Azibo
AU  - Daniel Agwenig Ndisang
AU  - Stewart Ndutard Ngasa
AU  - Leo Cedric Fozeu Fosso
Y1  - 2025/04/29
PY  - 2025
N1  - https://doi.org/10.11648/j.hep.20251002.13
DO  - 10.11648/j.hep.20251002.13
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JF  - International Journal of Health Economics and Policy
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PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20251002.13
AB  - 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.

VL  - 10
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Therence Nwana Dingana

Tubah District Hospital, Regional Delegation of Public Health, Northwest Region, Cameroon; Psychiatry, Pennine Care NHS Foundation Trust, Manchester, United Kingdom

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http://orcid.org/0000-0002-3753-5645
Balgah Roland Azibo

College of Technology, University of Bamenda, Northwest Region, Cameroon

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http://orcid.org/0000-0002-6117-2282
Daniel Agwenig Ndisang

Tubah District Hospital, Regional Delegation of Public Health, Northwest Region, Cameroon

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http://orcid.org/0009-0005-0496-7352
Stewart Ndutard Ngasa

Psychiatry, Pennine Care NHS Foundation Trust, Manchester, United Kingdom; MAC Clinical Research, Liverpool, United Kingdom

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http://orcid.org/0000-0001-5954-9717
Leo Cedric Fozeu Fosso

Ndop District Hospital, Regional Delegation of Public Health, Northwest Region, Cameroon

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http://orcid.org/0000-0001-7498-280X

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Dingana, T. N., Azibo, B. R., Ndisang, D. A., Ngasa, S. N., Fosso, L. C. F. (2025). The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. International Journal of Health Economics and Policy, 10(2), 43-59. https://doi.org/10.11648/j.hep.20251002.13

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Dingana, T. N.; Azibo, B. R.; Ndisang, D. A.; Ngasa, S. N.; Fosso, L. C. F. The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. Int. J. Health Econ. Policy 2025, 10(2), 43-59. doi: 10.11648/j.hep.20251002.13

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Dingana TN, Azibo BR, Ndisang DA, Ngasa SN, Fosso LCF. The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon. Int J Health Econ Policy. 2025;10(2):43-59. doi: 10.11648/j.hep.20251002.13

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@article{10.11648/j.hep.20251002.13,
  author = {Therence Nwana Dingana and Balgah Roland Azibo and Daniel Agwenig Ndisang and Stewart Ndutard Ngasa and Leo Cedric Fozeu Fosso},
  title = {The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon
},
  journal = {International Journal of Health Economics and Policy},
  volume = {10},
  number = {2},
  pages = {43-59},
  doi = {10.11648/j.hep.20251002.13},
  url = {https://doi.org/10.11648/j.hep.20251002.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20251002.13},
  abstract = {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.
},
 year = {2025}
}

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TY  - JOUR
T1  - The Impact of the Performance-Based Financing Project: An Observational Panel Study on Health Workers' Output in Rural Mezam, Northwest Region, Cameroon

AU  - Therence Nwana Dingana
AU  - Balgah Roland Azibo
AU  - Daniel Agwenig Ndisang
AU  - Stewart Ndutard Ngasa
AU  - Leo Cedric Fozeu Fosso
Y1  - 2025/04/29
PY  - 2025
N1  - https://doi.org/10.11648/j.hep.20251002.13
DO  - 10.11648/j.hep.20251002.13
T2  - International Journal of Health Economics and Policy
JF  - International Journal of Health Economics and Policy
JO  - International Journal of Health Economics and Policy
SP  - 43
EP  - 59
PB  - Science Publishing Group
SN  - 2578-9309
UR  - https://doi.org/10.11648/j.hep.20251002.13
AB  - 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.

VL  - 10
IS  - 2
ER  -

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