Like using a refrigerator to heat food: capacity and capability funding in primary care and the legacy of the Primary Health Organisation Performance Programme
Reuben Olugbenga Ayeleke 1 2 , Timothy Tenbensel 1 , Pushkar Raj Silwal 1 , Lisa Walton 11 School of Population Health, The University of Auckland, Auckland, New Zealand
2 Corresponding author. Email: r.ayeleke@auckland.ac.nz
Journal of Primary Health Care 12(4) 345-351 https://doi.org/10.1071/HC20012
Published: 9 December 2020
Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: In 2016, the New Zealand Ministry of Health introduced the System Level Measures (SLM) framework as a new approach to health system improvement that emphasised quality improvement and integration. A funding stream that was a legacy of past primary care performance management was repurposed as ‘capacity and capability’ funding to support the implementation of the SLM framework.
AIM: This study explored how the capacity and capability funding has been used and the issues and challenges that have arisen from the funding implementation.
METHODS: Semi-structured interviews with 50 key informants from 18 of New Zealand’s 20 health districts were conducted. Interview transcripts were coded using thematic analysis.
RESULTS: The capacity and capability funding was used in three different ways. Approximately one-third of districts used it to actively support quality improvement and integration initiatives. Another one-third tweaked existing performance incentive schemes and in the remaining one-third, the funding was passed directly on to general practices without strings attached. Three key issues were identified related to implementation of the capacity and capability funding: lack of clear guidance regarding the use of the funding; funding perceived as a barrier to integration; and funding seen as insufficient for intended purposes.
DISCUSSION: The capacity and capability funding was intended to support collaborative integration and quality improvement between health sector organisations at the district level. However, there is a mismatch between the purpose of the capacity and capability funding and its use in practice, which is primarily a product of incremental and inconsistent policy development regarding primary care improvement.
Keywords: Primary health care; funding incentives; performance; quality improvement; integration
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