Abstract for: Analysing the health system response to payment for performance interventions in Tanzania

The previous conventional evaluations of payment for performance (P4P) programmes in low- and middle-income countries (LMIC) have indicated how effective P4P can be in improving maternal and child health (MCH) services, but we still have limited understanding of how facilities and stakeholders respond to and transform under the programme. We intend to use system dynamics (SD) to model the P4P programme in Tanzania to understand how factors that have facilitated or hindered the implementation of P4P become more or less important over time, how P4P transforms health care delivery and utilisation pathways, and to identify leverage points that can induce positive system change to optimise further implementation of the P4P programme. We are currently developing causal loop diagrams (CLDs) representative of the demand and supply of MCH services in Tanzania using semi-structured interview data collected from stakeholders who participated in the piloted P4P programme in Tanzania. We have also compared our findings to an ongoing realist review of how P4P programmes operate in LMIC to establish how the mechanisms for system change identified in our model compare with those in other low-resource settings. Next steps include CLD validation using stakeholder interviews to refine system structure and feedback.