Impact of Performance-Based Financing (PBF) Program on Utilization and Completeness of Partographs in Jimma

Abstract

One of the most important quality thematic areas incentivized in PBF is maternity services which among other aspects include the use and completion of partographs when monitoring women in labor. Use f partographs during labor is a key intervention but it is not widely used due to various factors. Thus, the PBF program in Jimma sought to strengthen its use and completion since Q4 2019. A quasi-experimental design was used to review 7,260 mothers’ records from 2018, 2019 and 2021 from both Buno-Bedele (control) and Jimma (intervention) zones. Impact of the PBF program on partograph utilization and completeness was estimated using difference-in-differences (DiD) models in STATA 15. In 2019, partograph utilization was estimated to be 29.2% (CI: 26.6% - 31.8%) in Jimma and 23.5% (CI: 21.1% - 25.9%) in Buno-Bedele. In 2021, utilization increased to 87.2% (CI: 85.3% - 89.2%) in Jimma and 41.4% (CI: 38.7% - 44.2%) in Buno-Bedele. Out of the labor cases monitored with partographs, the completeness was 60.2% (CI: 58.1% - 62.4%) in Jimma and 51.6% (CI: 49.5% - 53.6%) in Buno-Bedele in 2019. In 2021, the completeness increased to 83.2% (CI: 82.3% - 84.2%) in Jimma and but remained the same in Buno-Bedele, 51.3% (CI: 49.7% - 52.8%). PBF accelerated the rate of improvement for both utilization (DiD: 30.8%, p-value < 0.001) and completion (DiD: 24.9%, p-value < 0.001) of partographs. Incentivizing facilities to improve quality of care coupled with coaching and mentorship of health workers is effective in improving quality of service for pregnant women in labor and delivery.