Improving quality of care through payment for performance: examining effects on the availability and stock-out of essential medical commodities in Tanzania.

Peter Binyaruka,Josephine Borghi

doi:10.1111/tmi.12809

Abstract

To evaluate the effects of payment for performance (P4P) on the availability and stock-out rate of reproductive, maternal, newborn and child health (RMNCH) medical commodities in Tanzania and assess the distributional effects. The availability of RMNCH commodities (medicines, supplies and equipment) on the day of the survey, and stock-outs for at least one day in the 90 days prior to the survey, was measured in 75 intervention and 75 comparison facilities in January 2012 and 13 months later. Composite scores for each subgroup of commodities were generated. A difference-in-differences linear regression was used to estimate the effect of P4P on outcomes and differential effects by facility location, level of care, ownership and socio-economic status of the catchment population. We estimated a significant increase in the availability of medicines by 8.4 percentage points (P = 0.002) and an 8.3 percentage point increase (P = 0.050) in the availability of medical supplies. P4P had no effect on the availability of functioning equipment. Most items with a significant increase in availability also showed a significant reduction in stock-outs. Effects were generally equally distributed across facilities, with effects on stock-outs of many medicines being pro-poor, and greater effects in facilities in rural compared to urban districts. P4P can improve the availability of medicines and medical supplies, especially in poor, rural areas, when these commodities are incentivised at both facility and district levels, making services more acceptable, effective and affordable, enhancing progress towards universal health coverage.

Highlights

The availability of essential medical commodities is a key component of effective service delivery required for maintaining population health [1]
Effects were generally distributed across facilities, with effects on stock outs of many medicines being pro-poor, and greater effects in facilities in rural compared to urban districts
P4P can improve the availability of medicines and medical supplies, especially in poor, rural areas, when these commodities are incentivised at both facility and district levels, making services more acceptable, effective and affordable, enhancing progress towards universal health coverage

Summary

Introduction

The availability of essential medical commodities (medicines, medical supplies and equipment) is a key component of effective service delivery required for maintaining population health [1]. Shortages of medical commodities are associated with poor structural quality, or poor quality relating to the attributes of the setting in which care delivery occurs [2, 3], low levels of patient satisfaction, and preventable deaths [4,5,6,7,8,9]. Medicine and supply shortages in public facilities are responsible for a large share of the out-of-pocket payments faced by households in low and middle income settings limiting the affordability of care [1, 10]. P4P could theoretically affect the availability of medical commodities by, for example, incentivising the provision of intermittent preventive treatment (IPT) for malaria during antenatal care (ANC); through facility-level bonus payments which can be used to procure commodities; and by incentivising district managers to reduce drug stock out rates

Methods

Results

Conclusion