No impact of performance-based financing on the availability of essential medicines in Burkina Faso: A mixed-methods study

Abstract

Access to safe, effective, and affordable essential medicines (EM) is critical to quality health services and as such has played a key role in innovative health system strengthening approaches such as Performance-based Financing (PBF). Available literature indicates that PBF can improve EM availability, but has not done so consistently in the past. Qualitative explorations of the reasons are yet scarce. We contribute to expanding the literature by estimating the impact of PBF on EM availability and stockout in Burkina Faso and investigating mechanisms of and barriers to change. The study used an explanatory mixed methods design. The quantitative study component followed a quasi-experimental design (difference-in-differences), comparing how EM availability and stockout had changed three years after implementation in 12 PBF and in 12 control districts. Qualitative data was collected from purposely selected policy and implementation stakeholders at all levels of the health system and community, using in-depth interviews and focus group discussions, and explored using deductive coding and thematic analysis. We found no impact of PBF on EM availability and stockouts in the quantitative data. Qualitative narratives converge in that EM supply had increased as a result of PBF, albeit not fully satisfactorily and sustainably so. Reasons include persisting contextual challenges, most importantly a public medicine procurement monopoly; design challenges, specifically a disconnect and disbalance in incentive levels between service provision and service quality indicators; implementation challenges including payment delays, issues around performance verification, and insufficient implementation of activities to strengthen stock management skills; and concurrently implemented policies, most importantly a national user fee exemption for children and pregnant women half way through the impact evaluation period. The case of PBF and EM availability in Burkina Faso illustrates the difficulty of incentivizing and effecting holistic change in EM availability in the presence of strong contextual constraints and powerful concurrent policies.

Healthcare system’s preparedness to provide cardiovascular and diabetes-specific care in the context of geopolitical crises in Burkina Faso: a trend analysis from 2012 to 2018

“…31 The situation of availability of essential CVD medicine in Burkina Faso might be due to contextual constraints and powerful concurrent policies, which make it difficult for a holistic change in essential medicine availability. 39 The availability of guidelines was among the lowest tracer in this study. Peck et al 5 reported in 2014 that in many facilities in Tanzania, guidelines, diagnostic equipment and first-line drug therapy for the primary care of NCD were inadequate, and the management, training and reporting systems were weak.…”

“…To reduce the premature deaths from NCDs by 25% by 2025, as highlighted in the Global NCD plan, at least 50% of the eligible people must receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes 31. The situation of availability of essential CVD medicine in Burkina Faso might be due to contextual constraints and powerful concurrent policies, which make it difficult for a holistic change in essential medicine availability 39. The availability of guidelines was among the lowest tracer in this study.…”

Acesso aos contraceptivos e direito à saúde em Angola: experiências de mulher e de farmacêutica

“…A observação de abundância de medicamentos contraceptivos estocados, mas fora do alcance das mulheres, contrasta com a preconcepção comum de que os problemas de acessibilidade aos medicamentos em países de baixa renda se definem pela indisponibilidade de recursos públicos para aquisição, ou da insuficiência de produtos oriundos de ações humanitárias internacionais [28][29][30][31][32] . O caso observado revela que, se por um acaso o coordenador da unidade sanitária também entender que contracepção 'é coisa do Ocidente' e que tem que deixar as crianças nascerem, não haverá contraceptivos disponíveis nas unidades de saúde e, portanto, não haverá acesso a eles.…”

How a supply‐side intervention can help to increase caesarean section rates in Burkina Faso facilities—Evidence from an interrupted time‐series analysis using routine health data

“…These items are particularly important in the treatment of obstetric complications, especially in the case of a CS. A recent study showed that in Burkina Faso, a PBF programme had no impact on the availability of essential medicine due to contextual constraints and other policies implemented in the country [ 27 ]. In Burkina Faso, the lack of material resources to perform CS is particularly problematic.…”