Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe

Fichera, Eleonora; Anselmi, Laura; Gwati, Gwati; Brown, Garrett Wallace; Kovacs, Roxanne; Borghi, Josephine

doi:10.1016/j.socscimed.2021.113959

Cited by 8 publications

(12 citation statements)

References 39 publications

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“…In line with similar evaluations (Bonfrer et al, 2014;Fichera et al, 2021;Gage & Bauhoff, 2021;Sherry et al, 2017;Van de Poel et al, 2016), we defined exposure as residence in a PBF district, at the time of conception (9 months prior to the date of birth), assuming that the mother had not moved between then and the interview.…”

Section: Average Effectsmentioning

confidence: 99%

“…Heterogenous outcomes by wealth, education, or contextual characteristics, may reflect differences in the opportunity cost of seeking or using care, and highlight the presence of demand-side constraints (Binyaruka et al, 2018(Binyaruka et al, , 2020Fichera et al, 2021;Van de Poel et al, 2016).…”

Section: Heterogenous Effects By Wealth Education and Provincementioning

confidence: 99%

“…We replicated the analysis for each subgroup separately, as in similar recent studies (Fichera et al, 2021). We characterized sub-groups by mother's wealth (three lower vs. two higher quintiles), and education (up to four vs. five or more), with thresholds approximately defined by the median.…”

Section: Heterogenous Effects By Wealth Education and Provincementioning

confidence: 99%

“…Most evaluations showed mixed evidence regarding the average program effects on the delivery of targeted services (Das et al, 2016;Diaconu et al, 2021;Eijkenaar et al, 2013;Mendelson et al, 2017;Miller & Babiarz, 2013;Renmans et al, 2016;Scott et al, 2011Scott et al, , 2016Witter et al, 2012;Zaresani et al, 2021). There is emerging evidence of heterogeneous effects, which vary by beneficiaries' socio-economic status (Binyaruka et al, 2018(Binyaruka et al, , 2020Fichera et al, 2021;Van de Poel et al, 2016), and an increasing interest in the mechanisms that may explain the observed differences in the effects (Singh et al, 2021).…”

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confidence: 99%

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The impact of performance‐based financing within local health systems: Evidence from Mozambique

et al. 2023

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Most evidence on Performance Based Financing (PBF) in low‐income settings has focused on services delivered by providers in targeted health administrations, with limited understanding of how effects on health and care vary within them. We evaluated the population effects of a program implemented in two provinces in Mozambique, focusing on child, maternal and HIV/AIDS care and knowledge. We used a difference‐in‐difference estimation strategy applied to data on mothers from the Demographic Health Surveys, linked to information on their closest health facility. The impact of PBF was limited. HIV testing during antenatal care increased, particularly for women who were wealthier, more educated, or residing in Gaza Province. Knowledge about transmission of HIV from mother‐to‐child, and its prevention, increased, particularly for women who were less wealthy, less educated, or residing in Nampula Province. Exploiting the roll‐out by facility, we found that the effects were concentrated on less wealthy and less educated women, whose closest facility was in the referral network of a PBF facility. Results suggest that HIV testing and knowledge promotion increased in the whole district, as a strategy to boost referral for highly incentivized HIV services delivered in PBF facilities. However, demand‐side constraints may prevent the use of those services.

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Section: Average Effectsmentioning

confidence: 99%

Section: Heterogenous Effects By Wealth Education and Provincementioning

confidence: 99%

Section: Heterogenous Effects By Wealth Education and Provincementioning

confidence: 99%

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confidence: 99%

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The impact of performance‐based financing within local health systems: Evidence from Mozambique

et al. 2023

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“… 25 In low-income settings, a few studies have examined how incentive effects vary over time, with mixed effects reported in Mozambique 15 and Zimbabwe. 26 However, these studies did not explore the reasons for changes in the effectiveness of P4P over time. Thus, there is a need for more evidence from LMICs to better understand the dynamic temporal effects of P4P schemes, and how and under which circumstances changes in effects occur.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

et al. 2021

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BackgroundThe success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.MethodsWe conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.ResultsProgramme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.ConclusionOur study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.

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“Across the Border, You Are Treated Well, They Care”: Patients and Therapeutic (Im)mobilities in the Honde Valley and Zambezi Borderlands

Nyachega

Matanzima

2023

Springer Geography

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Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe

Cited by 8 publications

References 39 publications

The impact of performance‐based financing within local health systems: Evidence from Mozambique

The impact of performance‐based financing within local health systems: Evidence from Mozambique

Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania

“Across the Border, You Are Treated Well, They Care”: Patients and Therapeutic (Im)mobilities in the Honde Valley and Zambezi Borderlands

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