Impact of Performance‐Based Financing on effective coverage for curative child health services in Burkina Faso: Evidence from a quasi‐experimental design

Abstract

Objective To evaluate the impact of Performance‐Based Financing (PBF) on effective coverage of child curative health services in primary healthcare facilities in Burkina Faso. Methods An impact evaluation of a PBF pilot programme, using an experiment nested within a quasi‐experimental design, was carried out in 12 intervention and 12 comparison districts in six regions of Burkina Faso. Across the 24 districts, primary healthcare facilities (537 both at baseline and endline) and households (baseline = 7978 endline = 7898) were surveyed. Within these households, 12 350 and 15 021 under‐five‐year‐olds caretakers were interviewed at baseline and endline respectively. Linking service quality to service utilisation, we used difference‐in‐differences to estimate the impact of PBF on effective coverage of curative child health services. Results Our study failed to detect any effect of PBF on effective coverage. Looking specifically into quality of care indicators, we detected a positive effect of PBF on structural elements of quality of care related to general service readiness, but not on the overall facility quality score, capturing both service readiness and the content of childcare. Conclusion The current study makes a unique contribution to PBF literature, as this is the first study assessing PBF impact on effective coverage for curative child health services in low‐income settings. The absence of any significant effects of PBF on effective coverage suggests that PBF programmes require a stronger design focus on quality of care elements especially when implemented in a context of free healthcare policy.

Improving the readiness and clinical quality of antenatal care – findings from a quasi-experimental evaluation of a performance-based financing scheme in Burkina Faso

“…The positive impact of the Burkina PBF on facilities' readiness to provide primary healthcare was also observed for other primary care services, such as child health care [28]. It therefore seems that the Burkina PBF was successful in improving the availability of key inputs across incentivized services.…”

“…The observed effect on service readiness in combination with absent effects on content of care in our findings further illustrate the disconnect between clinical inputs and processes. In the case of the Burkina PBF, this disconnect has also been found between service readiness and care processes related to incentivized outpatient care provided to children [33]. Given the weak correlation between the predictability of clinical performance based on the availability of service inputs across countries in SSA [34], the selection of performance-based incentives in PBF designs should probably have a stronger focus on clinical processes to produce more pronounced effects on overall service quality.…”

Nutritional status of children under five years and associated factors in 24 districts of Burkina Faso

“…The present study used data from a baseline household survey conducted in the context of the impact evaluation of the Performance-Based Financing (PBF) program in Burkina Faso [30]. Details of this study have been published elsewhere [31][32][33]. In brief, a household survey was carried out from October 15, 2013, to March 15, 2014, to provide basic indicators for assessing the impact of the PBF initiative on the quality and use of maternal and child health services.…”

To What Extent Do Free Healthcare Policies and Performance-Based Financing Reduce Out-Of-Pocket Expenditures for Outpatient services? Evidence From a Quasi-Experimental Study in Burkina Faso

“…12,13 The abovementioned efforts aimed at strengthening health financing towards UHC in Burkina Faso have been accompanied by substantial research. A number of studies have been conducted to assess the impact of user fee removal pilots, 3,14-25 PBF, [26][27][28][29][30][31][32][33][34] and more recently the gratuité. 31,[35][36][37][38][39][40] In general, however, existing studies have focused primarily on assessing the effects of policy reforms on equitable access to quality healthcare rather than on financial protection.…”