Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi

被引：14

作者：

Brenner, Stephan ^{[1
]}

Mazalale, Jacob ^{[2
]}

Wilhelm, Danielle ^{[1
]}

Nesbitt, Robin C. ^{[1
]}

Lohela, Terhi J. ^{[3
]}

Chinkhumba, Jobiba ^{[4
]}

Lohmann, Julia ^{[1
]}

Muula, Adamson S. ^{[5
]}

De Allegri, Manuela ^{[1
]}

机构：

[1] Heidelberg Univ, Heidelberg Inst Global Hlth, Neuenheimer Feld 130-3, D-69120 Heidelberg, Germany

[2] Univ Malawi, Dept Econ, Chancellor Coll, Zomba, Malawi

[3] Univ Helsinki, Dept Publ Hlth, POB 20, FI-00014 Helsinki, Finland

[4] Univ Malawi, Coll Med, Blantyre, Malawi

[5] Univ Malawi, Sch Publ Hlth & Family Med, Dept Publ Hlth, Blantyre, Malawi

来源：

BMC HEALTH SERVICES RESEARCH | 2018年 / 18卷

关键词：

Results-based financing; Effective coverage; Maternal and child health; Quality of care; Health care financing; HEALTH-CARE; PERFORMANCE; QUALITY;

D O I：

10.1186/s12913-018-3589-5

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied. Methods: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation. Results: There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program's potential to produce stronger effects. Conclusion: The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.

引用

页数：10

共 34 条

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