Performance-based financing for improving HIV/AIDS service delivery: a systematic review

Amitabh B Suthar,Till Bärnighausen,Eyerusalem K Negussie,Sabin Nsanzimana,Meg C Doherty,Jason M Nagata

doi:10.1186/s12913-016-1962-9

Abstract

BackgroundAlthough domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.MethodsPubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.ResultsFour studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.ConclusionsAlthough the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

Highlights

Domestic Human immunodeficiency virus (HIV)/Acquired immune deficiency syndrome (AIDS) financing is increasing, international HIV/AIDS financing has plateaued
I.e. ensuring all people obtain the health services they need without suffering financial hardship, has emerged as the health system foundation for the post-2015 global strategy for HIV, viral hepatitis, and sexually transmitted infections [6]
In some lowand middle-income countries, HIV/AIDS funds could be mobilised from tax revenue, social health insurance, the Global Fund (GFATM), and/or the United States President’s Emergency Plan for AIDS Relief (PEPFAR)

Summary

Introduction

Domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Social mobilisation, and funding have increased rapidly since the 2001 global declaration to address HIV/AIDS [1] This has translated into substantial progress in controlling the epidemic, including meeting the United Nations General Assembly target of expanding access to antiretroviral therapy (ART) to over 15 million people in 2015 [2]. In some lowand middle-income countries, HIV/AIDS funds could be mobilised from tax revenue, social health insurance, the Global Fund (GFATM), and/or the United States President’s Emergency Plan for AIDS Relief (PEPFAR). These domestic and external funds are sometimes pooled within national programmes and invested into services, medicines, and diagnostics needed for epidemic control. Performance-based financing (PBF) predominantly provides financial incentives for the health system based on the quantity and quality of health services [10]

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Conclusion