Abstract
Background: Since 2011, Benin adhered to results-based financing (RBF), with the implementation of RBF_PRPSS model by Health System Performance Strengthening Project (PRPSS) and RBF_PASS model by health system support project (PASS). Notwithstanding the lack of evidence on this experimental phase, the Ministry of Health initiated the extension of the RBF_PRPSS model to uncovered areas. This comparative study was led to evaluate the health system performance in RBF zones.Methods: The study examined data from sixty-seven health facilities in six health zones offering maternal and child health services, using the double difference, the Student's test and the variance comparison, with 5% significance level.Results: The study found that between 2011 and 2014, staff numbers remained stable in the RBF strata (p>0.05). The cumulative duration over a six-month period of stock-outs of five key drugs (paracetamol, amoxicillin, oxytocin, iron, sulfadoxine pyrimetamine) decreased from 51 days to 29 days (p<0.05). Direct revenues per health facility increased more in the RBF strata (p<0.05). Financial viability increased in RBF_PRPSS stratum. Health services utilization improved significantly for institutional delivery, tetanus toxoid immunization, DTP (Hib) HepB 3 and MCV immunization and curative care. Decreasing of maternal and neonatal mortalities in RBF strata were not significant.Conclusions: In sum, the RBF implementation has not yet generated a significant effect on the overall performance of the health system in exposed areas, although it is already accompanied by a significant improvement in the utilization of certain health care services.
Highlights
IntroductionImportant health system outcomes on service utilization and quality of care are attributed to the results-based financing (RBF).[3,4,5] These different results justify the growing interest for this intervention in sub-Saharan Africa where it is seen as a springboard that can guarantee more success to other interventions in the health sector
Results-based financing (RBF) is one of referenced contractual approaches that are attracting attention in developing countries and the support of financial partners who see it as a way to accelerate the performance of health systems.[1,2]
The health facilities located in the chief town of the commune, whose technical platform and staffs are often larger, were four in the RBF_PRPSS and RBF_PASS strata, and three in the stratum Non_RBF (Figure 2)
Summary
Important health system outcomes on service utilization and quality of care are attributed to the RBF.[3,4,5] These different results justify the growing interest for this intervention in sub-Saharan Africa where it is seen as a springboard that can guarantee more success to other interventions in the health sector. Notwithstanding the lack of evidence on this experimental phase, the Ministry of Health initiated the extension of the RBF_PRPSS model to uncovered areas. This comparative study was led to evaluate the health system performance in RBF zones. Conclusions: In sum, the RBF implementation has not yet generated a significant effect on the overall performance of the health system in exposed areas, it is already accompanied by a significant improvement in the utilization of certain health care services
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