Abstract
BackgroundThe low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications.Methods/DesignThe study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods.DiscussionPerformance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.
Highlights
The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality
According to the model proposed by the World Bank, bonus payments to health providers are made after verification by reviewers of the quantity and quality of healthcare services
The underlying assumption of performance-based financing (PBF) is that financial incentives, combined with increased supervision and enhanced autonomy, will motivate health providers to improve the quantity and quality of services delivered [8]
Summary
The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. Universal health coverage entails that everyone should have access to good quality healthcare services without experiencing financial hardship resulting from healthcare payment [1]. PBF generally entails that performance agreements between Ministries of Health and healthcare facilities are established to define indicators and targets to be reached in delivering these services. According to the model proposed by the World Bank, bonus payments to health providers are made after verification by reviewers of the quantity and quality of healthcare services. The underlying assumption of PBF is that financial incentives, combined with increased supervision and enhanced autonomy, will motivate health providers to improve the quantity and quality of services delivered [8]
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