Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it’s generalisability across settings

21069 6 112106 2 338601 document 112106 1-s2.0-S2949856225000340-main.pdf application/pdf 4a3c262de2c18d460f088ca0d724da8c MD5 2895543 2025-12-09 14:13:02 https://pure.iiasa.ac.at/id/eprint/21069/1/1-s2.0-S2949856225000340-main.pdf 21069 1 1 application/pdf text en public cc_by_nc_nd_4

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published 112107 1 338607 document 112107 indexcodes.txt text/plain 4e183caa71a99bedfa87814cad8adba9 MD5 15280 2025-12-09 14:22:49 https://pure.iiasa.ac.at/id/eprint/21069/2/indexcodes.txt 21069 2 2 text/plain other Generate index codes conversion from text to indexcodes en public

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http://eprints.org/relation/isVersionOf https://pure.iiasa.ac.at/id/document/112106 http://eprints.org/relation/isVolatileVersionOf https://pure.iiasa.ac.at/id/document/112106 http://eprints.org/relation/issmallThumbnailVersionOf https://pure.iiasa.ac.at/id/document/112106 archive 353 disk0/00/02/10/69 2025-12-09 14:14:21 2025-12-09 14:14:21 2025-12-09 14:14:21 article show Chama-Chiliba C.M. Sachingongu N. Cassidy R. Binyaruka P. Chansa C. Semwanga A.R. Borghi J. 9448 0000-0002-0482-5451 Using causal loop diagrams to explore the maternal and child health system response to payment for performance in Zambia, and it’s generalisability across settings pub POPJUS H2A Causal loop diagram; Health system; Maternal and child health; Payment for performance; Tanzania; Zambia This study investigates the generalisability of pathways depicted by causal loop diagrams (CLDs) in payment for performance (P4P) schemes by adapting and validating the Tanzanian CLDs to the Zambian context. Specifically, it explores whether the health system pathways represented by CLDs, are consistent across different settings and how variations in programme design and local context influence these pathways. Using a five-stage approach, the study adapted the Tanzanian CLDs to reflect the Zambian P4P programme context, validating them through stakeholder interviews, workshops, and secondary qualitative data. The findings show that while the overarching pathways influencing P4P outcomes are similar, differences in programme design and contextual factors shape their intensity and impact. Notably, Zambia's higher facility autonomy and stronger trust in the health system contributed to greater health worker motivation and service delivery compared to Tanzania. Programme design features such as safeguards for non-incentivised services and adequate funding for facility investment with provider autonomy influenced performance outcomes. Additionally, contextual factors such as trust in the system mitigated programme delays, while decentralised procurement systems enhanced P4P effectiveness. These findings highlight the need for context-specific adaptation when implementing P4P programmes. The study advances the application of CLDs for cross-country health system analysis, highlighting both their potential and limitations in comparing health interventions across diverse settings. 2025-12 published doi:10.1016/j.ssmhs.2025.100082 3380 public SSM - Health Systems 5 e100082 1 TRUE 29498562 info:eu-repo/semantics/article