A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries

Wright, Jenna; Eichler, Rena

doi:10.1080/23288604.2018.1440344

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Even as few studies explicitly link country context to PBF implementation and its impact on quality of care, these results are in line with other evaluations: across a wide range of countries, PBF’s impact on quality was found to benefit structural dimensions of quality more than process and outcome measures. 18 A recent study from Mali using a very similar approach 19 also identified the significant role of baseline implementation context, specifically in terms of the role and capacity of decentralised entities prior to implementation. Studies from Benin, Democratic Republic of the Congo, Rwanda and Zambia demonstrate that the conditionality aspect of PBF is associated with improved reporting and improved provider motivation, improved provider effort for incentivised services, with limited to no positive impact for non-incentivised services.…”

Section: Discussionmentioning

confidence: 99%

The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

et al. 2020

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Low quality of care is a significant problem for health systems in low-income and middle-income countries (LMICs). Policymakers are increasingly interested in using performance-based financing (PBF), a system-wide provider payment reform, conditioned on both quantity and quality of performance, to improve quality of care. The health system context influences both the design and the implementation of these programmes and thus their effectiveness. This study analyses how context has influenced the design and implementation of PBF in improving the quality of primary care in one particular setting, Cote d’Ivoire, a lower-middle income country with some of the poorest health outcomes in the world. Based on literature, an analytical framework was developed identifying five pathways through which financial incentives can influence the quality of primary care: earmarking, conditioning, provider behaviour, community involvement and management. Guided by this framework, semistructured interviews were conducted with policymakers and providers to diagnose the context and to assess the links between financing and quality of care at the primary care level. PBF in Cote d’Ivoire was found to have increased data availability and quality, facility-wide and disease-specific inputs, provider motivation and management practices in contracted facilities, but had limited success in improving process and outcome measures of quality, as well as community involvement and the provision of non-incentivised services. These limitations were attributable to a centralised health system structure constraining the decision space of health providers; financing and governance challenges across the health sector; and shortcomings with regard to the design of the PBF quality checklist and incentive structures in Cote d’Ivoire. In order to improve the quality of primary care, health sector reforms such as PBF should incorporate the organisational and service delivery context more broadly into their design and implementation, as is the case in other countries.

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Section: Discussionmentioning

confidence: 99%

The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

et al. 2020

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“…Following the literature (10,12,32), we posit that capitation will affect CS rates through a number of channels. We expect capitation to improve gatekeeping, adherence to guidelines and continuity of care ensured by the preferred primary provider (PPP) requirement.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…Accountability mechanisms have typically accompanied these to counter each payment system's deleterious effects, especially the provision of sub-optimal or unnecessary care. The evidence of these payment mechanisms on maternal healthcare has been mixed, both in high income countries (12) and in LMICS (13).…”

Section: Introductionmentioning

confidence: 99%

Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

Yambah¹,

Kuunibe²,

Laar³

et al. 2022

Ann. Afr. Med

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Context and objectives. In Ghana, CS rates have increased by 2% since 2014 even though the World Health Organization has called for the procedure only for medically justifiable cases. Provider payment mechanisms such as capitation have been used to moderate CS rates in some settings. We explored the effects of the withdrawal of the capitation policy on the Cesarean Surgery (CS) rate in public primary care hospitals together with vaginal delivery (VD) and antenatal care for women with 4+ visits (ANC4+) rates. Methods. An interrupted time-series analytical design was used to assess the effects of the withdrawal of capitation on selected variables from the secondary District Health Information Management System (DHIMS 2) of public hospitals between January 2015 and December 2019. Results: The results show that after the policy withdrawal, the trend and level of provision of CS and VD were not significantly altered. Significant declining trends of ANC4+ reversed with significant positive trends after the policy removal. Conclusion. We conclude that the withdrawal of the capitation policy may not have impacted the CS rate significantly in public hospitals. Enhanced capitation payment mechanisms and specific policies aimed at limiting CS are needed to curtail the rise in Ghana.

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“…Health systems have developed different payment systems to balance incentives for service provision with the need for cost control [2]. However, many of these payment system reforms have mixed results on service provision [2,3] and maternal health services in particular [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Capitation as a payment mechanism is uncommon in African health systems. Currently, many African countries are using capitation in combination with other payment methods [24,25]. Kenya is a case in point where capitation was combined with Fee for Service for provider payment [24].…”

Section: Introductionmentioning

confidence: 99%

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

Yambah

Mensah

Kuunibe

et al. 2022

glob health res policy

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Background Payment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap. Methods We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals. Results The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient − 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals. Conclusions The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.

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A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries

Cited by 6 publications

References 18 publications

The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

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