Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Steenland, Maria W.; Robyn, Paul Jacob; Compaore, Philippe; Kaboré, Moussa; Tapsoba, Boukary; Zongo, Aloys; Haidara, Ousmane; Fink, Günther

doi:10.1016/j.ssmph.2017.01.001

Cited by 42 publications

(44 citation statements)

References 25 publications

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“…Conversely the Volta region recorded a statistically signi cant reduction in the ANC four visit with estimated impact of -0.011 (95% CI: -0.020, -0.002; p-value < 0.01) as shown in supplementary table 1. The increased attendance are consistent with an impact evaluation of a PBF scheme in the Burkina Faso which asserted that the introduction of performance-based nancing (PBF) incentives increased the utilisation and coverage of maternal health services chief of it been increased ANC visits [20].…”

Section: Discussionsupporting

confidence: 76%

“…Poor socioeconomic status, high user fees, inaccessibility to essential healthcare services, poorly motivated providers and reduced service quality in many healthcare setting have been identi ed as causes of low utilization of maternal health services [6,7,8]. These factors have led to the death of over half a million women during the prenatal, delivery or the postnatal stages [6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis

Mohammed¹,

Dwomoh²,

Nonvignon³

2020

Preprint

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Background Improving maternal and child health outcomes (MCH) continues to be a major public health concern to governments in sub-Saharan Africa and the international development community. The Maternal and Child Health and Nutrition Improvement Project (MCHNP) was a nationwide project that sought to improve the utilization of maternal and child health services in Ghana through financial incentive packages. The objective of this study was to determine the differential impact of MCHNP on maternal and child health outcomes. Methods A retrospective longitudinal pre-test post-test study design was employed. The study used monthly data from the District Health Information Management System between January 2014 to December 2018. Interrupted time series analysis was applied to estimate the impact of MCHNP on MCH for each region of the country. Results Neonatal mortality rate increased significantly in the Western,Upper East and Upper West regions with impact estimates of 0.144 (95% CI: 0.100, 0.188; p-value < 0.001), 0.124 (95% CI: 0.076, 0.172; p-value < 0.001) and 0.082 (95% CI: 0.048, 0.117; p-value < 0.001) respectively. The proportion of women who had four ANC visits decreased significantly in the Volta region with an impact of -0.011 (95% CI: -0.020, -0.002; p-value < 0.01), but increased in the Central, Western, Eastern, Upper East, and Upper West with estimated impacts of 0.004 (95% CI: -0.003, 0.011), 0.003 (95% CI: -0.003, 0.008), 0.002 (95% CI: -0.004, 0.008), 0.011 (95% CI: -0.004, 0.026) and 0.007 (95% CI: -0.012, 0.026) respectively though none of the increase was statistically significant. Skilled deliveries reduced in the Greater Accra, Volta, Ashanti and Brong-Ahafo regions with statistically insignificant estimated impacts of 0.006 (95% CI: -0.019, 0.007), 0.005 (95% CI: -0.015, 0.006), 0.005 (95% CI: -0.011, 0.002) and 0.004 (95% CI: -0.010, 0.002) respectively. Maternal mortality rate declined in Greater Accra by; 0.001 (95% CI: -0.018, 0.017), Volta; -0.010 (95% CI: -0.035, 0.016), Western; -0.009 (95% CI: -0.031, 0.013), Brong-Ahafo; -0.018 (95% CI: -0.052, 0.017), Eastern; -0.025 (95% CI: -0.064, 0.013) and Northern − 0.024 (95% CI: -0.060, 0.011) regions. Conclusion The nationwide implementation of MCHNP produced mixed results as some regions recorded positive (significant) impacts whereas others had no significant impacts on the outcome variables as expected following the implementation of the intervention, therefore the need for further studies to understand why the intervention failed to produce positive impacts in some regions.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis

Mohammed¹,

Dwomoh²,

Nonvignon³

2020

Preprint

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“…In Burkina Faso, following a prepilot project in 3 districts, the Ministry of Health and the World Bank deployed a PBF intervention in 12 additional districts in January 2014. Burkina Faso decided to innovate by including strategies aimed at improving equity and supporting demand for services.…”

Section: Introductionmentioning

confidence: 99%

“…9,12,13 Studies that are not funded by the agencies organizing PBF are still very rare in Africa, 4 as are studies on the implementation of such interventions. 14,15 In Burkina Faso, following a prepilot project in 3 districts, 16 the Ministry of Health and the World Bank deployed a PBF intervention in 12 additional districts in January 2014. Burkina Faso decided to innovate by including strategies aimed at improving equity and supporting demand for services.…”

Section: Introductionmentioning

confidence: 99%

Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study

Ridde

Yaogo²,

Zongo

et al. 2017

Health Planning & Management

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To improve health services' quantity and quality, African countries are increasingly engaging in performance‐based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post‐launch in late 2014.The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents.Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community‐based audits had yet been done. Distribution of bonuses varied from one centre to another.This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies.

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“…11 The Intervention In Burkina Faso, PBF was initially introduced in 2011 as a pre-pilot project in 3 health districts. In December 2013, following positive evaluation, 12 the initiative was expanded to 15 districts in six regions. The intervention is designed as a case-based payment model with a quality top-up 13,14 : Health facilities are paid subsidies according to the number of services provided from a pre-determined list of services primarily related to maternal and child health, and may receive a quality bonus if services satisfy quality norms and standards ("carrot-carrot approach").…”

Section: Introductionmentioning

confidence: 99%

Burkina Faso

2017

International Trade Statistics Yearbook (Ser. G)

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Background: Performance-based financing (PBF) is currently tested in many low-and middle-income countries as a health system strengthening strategy. One of the main mechanisms through which PBF is assumed to effect change is by motivating health workers to improve their service delivery performance. This article aims at a better understanding of such motivational effects of PBF. In particular, the study focused on organizational context factors and health workers' perceptions thereof as moderators of the motivational effects of PBF, which to date has been little explored. Methods: We conducted a multiple case study in 2 district hospitals and 16 primary health facilities across three districts. Health facilities were purposely sampled according to pre-PBF performance levels. Within sampled facilities, 82 clinical skilled healthcare workers were in-depth interviewed one year after the start of the PBF intervention. Data were analyzed using a blended deductive and inductive process, using self-determination theory (SDT) as an analytical framework. Results: Results show that the extent to which PBF contributed to positive, sustainable forms of motivation depended on the "ground upon which PBF fell, " beyond health workers' individual personalities and disposition. In particular, health workers described three aspects of the organizational context in which PBF was implemented: the extent to which existing hierarchies fostered as opposed to hindered participation and transparency; managers' handling of the increased performance feedback inherent in PBF; and facility's pre-PBF levels in regards to infrastructure, equipment, and human resources. Conclusion: Our results underline the importance of leadership styles and pre-implementation performance levels in shaping health workers' motivational reactions to PBF. Ancillary interventions aimed at fostering participatory as opposed to directional leadership or start-up support to low-performing health facilities will likely boost PBF effects in regards to the development of valuable motivational capacities.

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Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Cited by 42 publications

References 25 publications

The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis

The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis

Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study

Burkina Faso

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