Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates? A difference-in-differences analysis from the Gambia

Sowe, Alieu; Namatovu, Fredinah; Cham, Bai; Gustafsson, Per E.

doi:10.1016/j.jvacx.2022.100206

Cited by 4 publications

(2 citation statements)

References 18 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vaccination is an important component supported by the program, being recognized as one of the pillars of infant mortality prevention. These results corroborate those obtained in similar studies [ 20 , 25 , 26 ] including in Nigeria where performance-based financing has contributed to polio eradication [ 27 ]. However, in some studies performance-based financing has not resulted in improved immunization coverage [ 28 , 29 ].…”

Section: Discussionsupporting

confidence: 92%

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

Tchouaket,

Karemere,

Sia

et al. 2023

J Epidemiol Glob Health

View full text Add to dashboard Cite

Access to universal health coverage is a fundamental right that ensures that even the most disadvantaged receive health services without financial hardship. The Democratic Republic of Congo is among the poorest countries in the world, yet healthcare is primarily made by direct payment which renders care inaccessible for most Congolese. Between 2017 and 2021 a purchasing of health services initiative (Le Programme de Renforcement de l’Offre et Développement de l’accès aux Soins de Santé or PRO DS), was implemented in Kongo Central and Ituri with the assistance of the non-governmental organization Memisa Belgium. The program provided funding for health system strengthening that included health service delivery, workforce development, improved infrastructure, access to medicines and support for leadership and governance. This study assessed the social and health impacts of the PRO DS Memisa program using a health impact assessment focus. A documentary review was performed to ascertain relevant indicators of program effect. Supervision and management of health zones and health centers, use of health and nutritional services, the population’s nutritional health, immunization levels, reproductive and maternal health, and newborn and child health were measured using a controlled longitudinal model. Positive results were found in almost all indicators across both provinces, with a mean proportion of positive effect of 60.8% for Kongo Central, and 70.8% in Ituri. Barriers to the program’s success included the arrival of COVID-19, internal displacement of the population and resistance to change from the community. The measurable positive impacts from the PRO DS Memisa program reveal that an adequately funded multi-faceted health system strengthening program can improve access to healthcare in a low-income country such as the Democratic Republic of Congo.

show abstract

Section: Discussionsupporting

confidence: 92%

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

Tchouaket,

Karemere,

Sia

et al. 2023

J Epidemiol Glob Health

View full text Add to dashboard Cite

show abstract

“…Existing literature found PbR to have little effect on extreme poverty (those in the lowest quintiles) [ 13 , 15 , 20 , 21 ] but to have positive effects on rural–urban inequalities [ 14 ]. Notably, many studies argued that PbR interventions tended to be clinic- or facility-based and did not necessarily address structural health system challenges [ 14 , 22 ], including: the large out-of-pocket expenditure for the ultra-poor [ 23 ], bias interpreting how to apply the criteria [ 15 ], and more practical barriers such as lack of transport and lack of awareness of the benefits [ 20 ]. Likewise, the strategies in WISH were focused on clinic- or outreach service-based, and this may have limited their effects.…”

Section: Discussionmentioning

confidence: 99%

Can payment by results ensure equitable access to contraceptive services? a qualitative case study

Boydell,

Holden,

Robins

et al. 2023

Int J Equity Health

View full text Add to dashboard Cite

Background The Leave No One Behind (LNOB) agenda compels sexual and reproductive health and rights (SRHR) implementers to focus on the multiple and intersecting forms of discrimination and inequalities. One strategy to address these is Payment by Results (PbR). Using the Women’s Integrated Sexual Health (WISH) programme as a case study, this paper examines if and how PbR can ensure equitable reach and impact. Methods Given the complexity of PbR mechanisms, a theory-based approach was used in the design and analysis of this evaluation, drawing on four case studies. These were conducted by reviewing global and national programme data and by interviewing 50 WISH partner staff at national level and WISH programme staff at global and regional levels. Results The case studies found that inclusion of equity-based indicators in the PbR mechanism had demonstrable effects on people’s incentives, on how systems work, and on modes of working. The WISH programme was successful in achieving its desired programme indicators. The use of Key Performance Indicators (KPIs) clearly incentivised several strategies for service providers to innovate and reach adolescents and people living in poverty. However, there were trade-offs between performance indicators that increased coverage and others that increased equitable access, as well as several systemic challenges that limited the possible incentive effects. Conclusions The use of PbR KPIs incentivised several strategies to reach adolescents and people living in poverty. However, the use of global indicators was too simplistic, resulting in several methodological issues.

show abstract

Missed opportunities for vaccination at point of care and their impact on coverage and urban–rural coverage inequity in the Gambia

Sowe,

Namatovu,

Cham

et al. 2023

Vaccine

View full text Add to dashboard Cite

Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates? A difference-in-differences analysis from the Gambia

Cited by 4 publications

References 18 publications

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

Can payment by results ensure equitable access to contraceptive services? a qualitative case study

Missed opportunities for vaccination at point of care and their impact on coverage and urban–rural coverage inequity in the Gambia

Contact Info

Product

Resources

About