Abstract
Toward the end of that scaling up of performance-based financing (PBF) started in Benin since 2015, it's important to realize whether the impacts in terms of performance improvement of health facilities (HFs) will still be confirmed or not, especially as far as family planning (FP) is concerned. A longitudinal retrospective study covered by the period of 14 quarters of a year (Q1 2014 to Q2 2017), was conducted including all public and private functional HFs of the two health district. The outcome variable (performance of HFs in FP) was the increase rates of new acceptance for any modern contraceptive method through the study period. The independent variables were the quality of the structure, the quality of the process and the context. A linear regression model was adjusted to find out the explanatory variable of the performance; the significance threshold was 5%. 55 HFs participated to the study. There was no improvement in supplying process of FP services (p=0.308). There was no improvement in both trained staff (p=0.67) and midwifery staff (p=0.75); however, there was a significant improvement in the rest of the structure at the risk of 10% (p=0.063) and the performance in FP (p<0.001). In multivariate analysis, the evolution of the structure was the only explanatory variable (p=0.029) of HFs performance in FP; in rural areas, the structure-process interaction (p=0.038) was the explanatory variable of HFs performance in FP, whereas in suburban and urban areas, the models were not significant. PBF should act not only on the structures but also on the processes of supplying services, taking into account the context.
Highlights
According to Canavan et al [1], Performance Based Financing (PBF) is a form of financing based on the assumption that the linking of motivations to performance would contribute to improving the accessibility, the quality and the equity in provision of health services
The objective of this study is to analyze the impact of PBF on health facilities (HFs) performance concerning family planning in PN and NKP health district, via the quality of the structure and the process of offering these services as well as the possible link between performance and the quality of the process, on the one hand, and the structure on the other
We conducted a longitudinal retrospective study in order to analyse the influence of the structures, processes and contexts of care provision in health facilities of the Parakou-N'Dali and Nikki-Kalalé-Pèrèrè health district exposed to PBF
Summary
According to Canavan et al [1], Performance Based Financing (PBF) is a form of financing based on the assumption that the linking of motivations to performance would contribute to improving the accessibility, the quality and the equity in provision of health services. The basic idea was to strengthen the performance of the health system mainly through [2]: (i) the implementation of the contractual approach (ii) the implementation of the quality improvement process of health care and services; and (iii) the introduction of financial incentives commensurate with the provision of quality of care and services to the population The results of these different experiments were conclusive especially as far as the improvement of the quality of care is concerned. Since the conditions of the pilot experiments are not the same as the one of the scaling up, it was important two years after the beginning of this generalization to see the impact of PBF on the performance of health facilities in terms of improvement of the quantity and quality of services offered to the population This took place in two health districts of Borgou administrative departments, namely Parakou-N'Dali (PN) district and Nikki-Kalalé-Pèrèrè (NKP) district
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