{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:04:14Z","timestamp":1789765454033,"version":"4.0.1"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100019273","name":"National Institute for Medical Research","doi-asserted-by":"publisher","award":["IX\/3154"],"award-info":[{"award-number":["IX\/3154"]}],"id":[{"id":"10.13039\/501100019273","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R013454\/1"],"award-info":[{"award-number":["MR\/R013454\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["16139 \\u2013 2"],"award-info":[{"award-number":["16139 \\u2013 2"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Social Science &amp; Medicine"],"published-print":{"date-parts":[[2021,9]]},"DOI":"10.1016\/j.socscimed.2021.114277","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T11:00:29Z","timestamp":1627470029000},"page":"114277","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":20,"special_numbering":"C","title":["Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach"],"prefix":"10.1016","volume":"285","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4824-0260","authenticated-orcid":false,"given":"Rachel","family":"Cassidy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrada","family":"Tomoaia-Cotisel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes Rwashana","family":"Semwanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Binyaruka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Chalabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Blanchet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0057-121X","authenticated-orcid":false,"given":"Neha S.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Maiba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0482-5451","authenticated-orcid":false,"given":"Josephine","family":"Borghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.socscimed.2021.114277_bib3","doi-asserted-by":"crossref","first-page":"e396","DOI":"10.1016\/S2214-109X(15)00059-5","article-title":"Tanzania's Countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015","volume":"3","author":"Afnan-Holmes","year":"2015","journal-title":"Lancet Glob Heal"},{"key":"10.1016\/j.socscimed.2021.114277_bib4","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1093\/heapol\/czx122","article-title":"Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan","volume":"32","author":"Alonge","year":"2017","journal-title":"Health Pol. Plann."},{"key":"10.1016\/j.socscimed.2021.114277_bib5","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1002\/sdr.1479","article-title":"The disconfirmatory interview as a strategy for the assessment of system dynamics models","volume":"28","author":"Andersen","year":"2012","journal-title":"Syst. Dynam. Rev."},{"key":"10.1016\/j.socscimed.2021.114277_bib6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13012-016-0540-1","article-title":"Understanding causal pathways within health systems policy evaluation through mediation analysis: an application to payment for performance (P4P) in Tanzania","volume":"12","author":"Anselmi","year":"2017","journal-title":"Implement. Sci."},{"key":"10.1016\/j.socscimed.2021.114277_bib7","doi-asserted-by":"crossref","DOI":"10.1093\/heapol\/czs088","article-title":"Health systems, systems thinking and innovation","volume":"27","author":"Atun","year":"2012","journal-title":"Health Pol. Plann."},{"key":"10.1016\/j.socscimed.2021.114277_bib8","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1093\/heapol\/czw002","article-title":"Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria","volume":"31","author":"Bhatnagar","year":"2016","journal-title":"Health Pol. Plann."},{"key":"10.1016\/j.socscimed.2021.114277_bib9","article-title":"Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania","volume":"5","author":"Binyaruka","year":"2020","journal-title":"BMJ Glob Heal"},{"key":"10.1016\/j.socscimed.2021.114277_bib10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/tmi.12809","article-title":"Improving quality of care through payment for performance: examining effects on the availability and stock-out of essential medical commodities in Tanzania","volume":"22","author":"Binyaruka","year":"2017","journal-title":"Trop. Med. Int. Health"},{"key":"10.1016\/j.socscimed.2021.114277_bib11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0135013","article-title":"Effect of paying for performance on utilisation, quality, and user costs of health services in Tanzania: a controlled before and after study","volume":"10","author":"Binyaruka","year":"2015","journal-title":"PloS One"},{"key":"10.1016\/j.socscimed.2021.114277_bib12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12939-018-0728-x","article-title":"Who benefits from increased service utilisation? Examining the distributional effects of payment for performance in Tanzania","volume":"17","author":"Binyaruka","year":"2018","journal-title":"Int. J. Equity Health"},{"key":"10.1016\/j.socscimed.2021.114277_bib13","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/heapol\/czy084","article-title":"Does payment for performance increase performance inequalities across health providers? A case study of Tanzania","volume":"33","author":"Binyaruka","year":"2018","journal-title":"Health Pol. Plann."},{"key":"10.1016\/j.socscimed.2021.114277_bib14","article-title":"Square peg in a round hole: re-thinking our approach to evaluating health system strengthening in low-income and middle-income countries","volume":"2","author":"Borghi","year":"2017","journal-title":"BMJ Glob Heal"},{"key":"10.1016\/j.socscimed.2021.114277_bib15","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/1748-5908-8-80","article-title":"Protocol for the evaluation of a pay for performance programme in Pwani region in Tanzania: a controlled before and after study","volume":"8","author":"Borghi","year":"2013","journal-title":"Implement. Sci."},{"key":"10.1016\/j.socscimed.2021.114277_bib16","doi-asserted-by":"crossref","first-page":"100325","DOI":"10.1016\/j.eclinm.2020.100325","article-title":"A systems approach to preventing and responding to COVID-19","volume":"21","author":"Bradley","year":"2020","journal-title":"EClinicalMedicine"},{"key":"10.1016\/j.socscimed.2021.114277_bib17","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1186\/s12889-016-2982-4","article-title":"Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review","volume":"16","author":"Das","year":"2016","journal-title":"BMC Publ. Health"},{"key":"10.1016\/j.socscimed.2021.114277_bib18","series-title":"Applied Systems Thinking for Health Systems Research\u00a0: a Methodological Handbook","article-title":"Conclusion: mapping methods to research challenges","author":"de Savigny","year":"2017"},{"key":"10.1016\/j.socscimed.2021.114277_bib19","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/ije\/dyv362","article-title":"Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial","volume":"45","author":"Engineer","year":"2016","journal-title":"Int. J. Epidemiol."},{"key":"10.1016\/j.socscimed.2021.114277_bib20","series-title":"Comparative Performance Evaluation: Quality. Encyclopedia of Health Economics","first-page":"111","author":"Fichera","year":"2014"},{"key":"10.1016\/j.socscimed.2021.114277_bib21","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/job.322","article-title":"Self-determination theory and work motivation","volume":"26","author":"Gagn\u00e9","year":"2005","journal-title":"J. Organ. Behav."},{"key":"10.1016\/j.socscimed.2021.114277_bib22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-040276","article-title":"Transformation of the Tanzania medical store department through global fund support: an impact assessment study","volume":"10","author":"Githendu","year":"2020","journal-title":"BMJ Open"},{"key":"10.1016\/j.socscimed.2021.114277_bib23","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1002\/sdr.1480","article-title":"Building confidence in causal maps generated from purposive text data: mapping transcripts of the Federal Reserve","volume":"28","author":"Kim","year":"2012","journal-title":"Syst. Dynam. Rev."},{"key":"10.1016\/j.socscimed.2021.114277_bib24","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1136\/bmj.39463.454815.94","article-title":"Payment for performance in health care","volume":"336","author":"Mannion","year":"2008","journal-title":"BMJ"},{"key":"10.1016\/j.socscimed.2021.114277_bib25","first-page":"305","article-title":"A method for eliciting and comparing causal maps","volume":"21","author":"Mark\u00f3czy","year":"1995","journal-title":"J. Manag."},{"key":"10.1016\/j.socscimed.2021.114277_bib26","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.socscimed.2017.02.022","article-title":"Effects of payment for performance on accountability mechanisms: evidence from Pwani, Tanzania","volume":"179","author":"Mayumana","year":"2017","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2021.114277_bib27","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/sres.2338","article-title":"Dynamic consequences of performance-based payment systems in public hospitals","volume":"32","author":"Meker","year":"2015","journal-title":"Syst. Res. Behav. Sci."},{"key":"10.1016\/j.socscimed.2021.114277_bib2","series-title":"The Pwani Region Pay-for-Performance (P4P) Pilot Design Document. Dar es Salaam","year":"2012"},{"key":"10.1016\/j.socscimed.2021.114277_bib1","unstructured":"MoHSW (Ministry of Health and Social Welfare), n.d. Result Based Financing, Operational Manual. Dar es Salaam: MoHSW, United Republic of Tanzania."},{"key":"10.1016\/j.socscimed.2021.114277_bib28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/heapol\/czw091","article-title":"Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs","volume":"32","author":"Ngo","year":"2017","journal-title":"Health Pol. Plann."},{"key":"10.1016\/j.socscimed.2021.114277_bib29","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1186\/1472-6963-14-392","article-title":"Pay for performance: an analysis of the context of implementation in a pilot project in Tanzania","volume":"14","author":"Olafsdottir","year":"2014","journal-title":"BMC Health Serv. Res."},{"key":"10.1016\/j.socscimed.2021.114277_bib30","first-page":"207","article-title":"Local stakeholders' perceptions about the introduction of performance-based financing in Benin: a case study in two health districts","volume":"3","author":"Paul","year":"2014","journal-title":"Int. J. Health Pol. Manag."},{"key":"10.1016\/j.socscimed.2021.114277_bib31","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/1478-4505-12-51","article-title":"The application of systems thinking in health: why use systems thinking?","volume":"12","author":"Peters","year":"2014","journal-title":"Health Res. Pol. Syst."},{"key":"10.1016\/j.socscimed.2021.114277_bib32","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.ejor.2015.05.043","article-title":"A system dynamics view of the acute bed blockage problem in the Irish healthcare system","volume":"247","author":"Rashwan","year":"2015","journal-title":"Eur. J. Oper. Res."},{"key":"10.1016\/j.socscimed.2021.114277_bib33","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.3390\/ijerph14091007","article-title":"Combining theory-driven evaluation and causal loop diagramming for opening the \u201cblack box\u201d of an intervention in the health sector: a case of performance-based financing in Western Uganda","volume":"14","author":"Renmans","year":"2017","journal-title":"Int. J. Environ. Res. Publ. Health"},{"key":"10.1016\/j.socscimed.2021.114277_bib34","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/ev.20424","article-title":"No mechanism without context: strengthening the analysis of context in realist evaluations using causal loop diagramming","volume":"2020","author":"Renmans","year":"2020","journal-title":"N. Dir. Eval."},{"key":"10.1016\/j.socscimed.2021.114277_bib35","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1478-4505-12-36","article-title":"Advancing the application of systems thinking in health: understanding the dynamics of neonatal mortality in Uganda","volume":"12","author":"Rwashana","year":"2014","journal-title":"Health Res. Pol. Syst."},{"key":"10.1016\/j.socscimed.2021.114277_bib36","doi-asserted-by":"crossref","first-page":"20","DOI":"10.3390\/systems8020020","article-title":"Developing a preliminary causal loop diagram for understanding the wicked complexity of the COVID-19 pandemic","volume":"8","author":"Sahin","year":"2020","journal-title":"Systems"},{"key":"10.1016\/j.socscimed.2021.114277_bib37","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.ejor.2010.09.003","article-title":"A comprehensive method for comparing mental models of dynamic systems","volume":"210","author":"Schaffernicht","year":"2011","journal-title":"Eur. J. Oper. Res."},{"key":"10.1016\/j.socscimed.2021.114277_bib38","doi-asserted-by":"crossref","DOI":"10.1177\/2050312116671953","article-title":"Emergency department crowding in Singapore: insights from a systems thinking approach","volume":"4","author":"Schoenenberger","year":"2016","journal-title":"SAGE Open Med"},{"key":"10.1016\/j.socscimed.2021.114277_bib39","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12960-017-0179-2","article-title":"Incentives to change: effects of performance-based financing on health workers in Zambia","volume":"15","author":"Shen","year":"2017","journal-title":"Hum. Resour. Health"},{"key":"10.1016\/j.socscimed.2021.114277_bib40","doi-asserted-by":"crossref","first-page":"113624","DOI":"10.1016\/j.socscimed.2020.113624","article-title":"A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries","volume":"270","author":"Singh","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2021.114277_bib41","series-title":"The Journey toward the Patient-Centered Medical Home: A Grounded, Dynamic Theory of Primary Care Transformation","author":"Tomoaia-Cotisel","year":"2018"},{"key":"10.1016\/j.socscimed.2021.114277_bib42","series-title":"Applied Systems Thinking for Health Systems Research\u00a0: a Methodological Handbook","article-title":"Causal loop diagrams: a tool for visualizing emergent system behaviour","author":"Tomoaia-Cotisel","year":"2017"},{"key":"10.1016\/j.socscimed.2021.114277_bib43","series-title":"Vensim PLE Plus","year":"2015"}],"container-title":["Social Science &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953621006092?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953621006092?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:18:37Z","timestamp":1789762717000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0277953621006092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":43,"alternative-id":["S0277953621006092"],"URL":"https:\/\/doi.org\/10.1016\/j.socscimed.2021.114277","relation":{},"ISSN":["0277-9536"],"issn-type":[{"value":"0277-9536","type":"print"}],"subject":[],"published":{"date-parts":[[2021,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach","name":"articletitle","label":"Article Title"},{"value":"Social Science & Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.socscimed.2021.114277","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"114277"}}