To strengthen the health care delivery, the Burundian Government in collaboration with internatio... more To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned-by using a simple matching method-to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-indifference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel. Keywords: performance-based financing, financial incentive, health quality indicators, quality of health services efforts so that they can improve the quality of care for getting more payments (
In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who ... more In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who had been treated for severe protein-energy malnutrition (PEM) wer traced after discharge from hospital for 5 years. Their nutritional status on admission was as follows: kwashiorkor 5% marasmus 1% marasmic kwashiorkor 93% nutritional dwarfism 1%. The average age on admission was 46 months. The proportion surviving to the end of 5th year was 0.816. This proportion surviving was lowest for the year following discharge from hospital especially for the youngest children. Follow-up included a clinical examination the measurement of height and weight and the determination of serum albumin by paper electrophoresis. No catch-up for weight and for height was observed and the serum albumin concentrations decreased after the 1st year. Neither weight for age nor height for age are associated in this study with increased frequency of death either at 1 year or at 5 years after discharge. There is no significant acceleration in growth for height or weight among survivors during the 5 years after discharge. Serum albumin concentrations at the end of the 1st year remain simiar to those observed on discharge but they decrease markedly thereafter. Children who suffer from PEM before the age of 2 have a decreased chance of survival the risk of death being particularly high during the 1st year of discharge.
In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric ma... more In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.
La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que d... more La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who ... more In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who had been treated for severe protein-energy malnutrition (PEM) wer traced after discharge from hospital for 5 years. Their nutritional status on admission was as follows: kwashiorkor 5% marasmus 1% marasmic kwashiorkor 93% nutritional dwarfism 1%. The average age on admission was 46 months. The proportion surviving to the end of 5th year was 0.816. This proportion surviving was lowest for the year following discharge from hospital especially for the youngest children. Follow-up included a clinical examination the measurement of height and weight and the determination of serum albumin by paper electrophoresis. No catch-up for weight and for height was observed and the serum albumin concentrations decreased after the 1st year. Neither weight for age nor height for age are associated in this study with increased frequency of death either at 1 year or at 5 years after discharge. There is no significant acceleration in growth for height or weight among survivors during the 5 years after discharge. Serum albumin concentrations at the end of the 1st year remain simiar to those observed on discharge but they decrease markedly thereafter. Children who suffer from PEM before the age of 2 have a decreased chance of survival the risk of death being particularly high during the 1st year of discharge.
INTRODUCTION Burundi introduced free healthcare for children under five and pregnant women in 200... more INTRODUCTION Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, this was linked to the Performance-Based Financing (PBF) approach. This article is designed to identify factors in these health financing reforms that have contributed to good governance in the health sector. METHODS Six criteria of good governance were used as an analytical framework. Results were derived from official reports and the international literature. RESULTS The main contributions of these reforms to good governance in Burundi were the separation of functions, transparency in management and a meticulous description of administrative procedures. Scrupulous monitoring resulted in several corrective measures. DISCUSSION Several unresolved questions remain, concerning the integration of vertical programmes and the sustainability of the system given the considerable costs, since funding is not yet fully ensured by the State and its partners.
This paper compares the results of two SBBN codes developped independently by different teams of ... more This paper compares the results of two SBBN codes developped independently by different teams of physicists. These two codes have significant differences that lead to a discrepency between their final mass fractions of 4 He of 0.003. This paper shows that the mass fractions of each code had different orders of convergence, and how the number of timesteps affects the accuracy of the mass fractions. At the end, the paper shows how to modify both codes so that their 4 He mass fractions agree to around 0.0001.
Background Performance-based financing (PBF) is an increasingly adopted strategy in lowand middle... more Background Performance-based financing (PBF) is an increasingly adopted strategy in lowand middle-income countries. PBF pilot projects started in Burundi in 2006, at the same time when a national policy removed user fees for pregnant women and children below 5 years old. PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services. PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P < 0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time. The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explanation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.
objective Community participation is often described as a key for primary health care in lowincom... more objective Community participation is often described as a key for primary health care in lowincome countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance. method We evaluated 100 health committees and 79 CBOs using original data collected in six Burundi provinces (2009)(2010) and a framework based on the literature on community participation in health and New Institutional Economics. results Health committees appear to be rather ineffective, focusing on supporting the medical staff and not on representing the population. CBOs do convey information about the concerns of the population to the health authorities; yet, they represent only a few users and lack the ability to force changes. PBF does not automatically imply more 'voice' from the population, but introduces an interesting complement to health committees with CBOs. However, important efforts remain necessary to make both mechanisms work. More experiments and analysis are needed to develop truly efficient 'downward' mechanisms of accountability at the HC level. keywords community participation, performance-based financing, primary health care, health systems, rural health centres, Burundi
In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric ma... more In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.
To strengthen the health care delivery, the Burundian Government in collaboration with internatio... more To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned -by using a simple matching method -to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care.
Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, t... more Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, this was linked to the Performance-Based Financing (PBF) approach. This article is designed to identify factors in these health financing reforms that have contributed to good governance in the health sector. Six criteria of good governance were used as an analytical framework. Results were derived from official reports and the international literature. The main contributions of these reforms to good governance in Burundi were the separation of functions, transparency in management and a meticulous description of administrative procedures. Scrupulous monitoring resulted in several corrective measures. Several unresolved questions remain, concerning the integration of vertical programmes and the sustainability of the system given the considerable costs, since funding is not yet fully ensured by the State and its partners.
Background: Performance-based financing (PBF) is an increasingly adopted strategy in low- and mid... more Background: Performance-based financing (PBF) is an increasingly adopted strategy in low- and middle-income countries. PBF pilot projects started in Burundi in 2006, at the same time when a national policy removed user fees for pregnant women and children below 5 years old.
Methods: PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services.
Results: PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P<0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time.
Discussion: The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explan- ation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.
objective Community participation is often described as a key for primary health care in lowincom... more objective Community participation is often described as a key for primary health care in lowincome countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance.
To strengthen the health care delivery, the Burundian Government in collaboration with internatio... more To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned-by using a simple matching method-to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-indifference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel. Keywords: performance-based financing, financial incentive, health quality indicators, quality of health services efforts so that they can improve the quality of care for getting more payments (
In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who ... more In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who had been treated for severe protein-energy malnutrition (PEM) wer traced after discharge from hospital for 5 years. Their nutritional status on admission was as follows: kwashiorkor 5% marasmus 1% marasmic kwashiorkor 93% nutritional dwarfism 1%. The average age on admission was 46 months. The proportion surviving to the end of 5th year was 0.816. This proportion surviving was lowest for the year following discharge from hospital especially for the youngest children. Follow-up included a clinical examination the measurement of height and weight and the determination of serum albumin by paper electrophoresis. No catch-up for weight and for height was observed and the serum albumin concentrations decreased after the 1st year. Neither weight for age nor height for age are associated in this study with increased frequency of death either at 1 year or at 5 years after discharge. There is no significant acceleration in growth for height or weight among survivors during the 5 years after discharge. Serum albumin concentrations at the end of the 1st year remain simiar to those observed on discharge but they decrease markedly thereafter. Children who suffer from PEM before the age of 2 have a decreased chance of survival the risk of death being particularly high during the 1st year of discharge.
In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric ma... more In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.
La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que d... more La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who ... more In an area in Eastern Zaire where protein-energy malnutrition is highly endemic 171 children who had been treated for severe protein-energy malnutrition (PEM) wer traced after discharge from hospital for 5 years. Their nutritional status on admission was as follows: kwashiorkor 5% marasmus 1% marasmic kwashiorkor 93% nutritional dwarfism 1%. The average age on admission was 46 months. The proportion surviving to the end of 5th year was 0.816. This proportion surviving was lowest for the year following discharge from hospital especially for the youngest children. Follow-up included a clinical examination the measurement of height and weight and the determination of serum albumin by paper electrophoresis. No catch-up for weight and for height was observed and the serum albumin concentrations decreased after the 1st year. Neither weight for age nor height for age are associated in this study with increased frequency of death either at 1 year or at 5 years after discharge. There is no significant acceleration in growth for height or weight among survivors during the 5 years after discharge. Serum albumin concentrations at the end of the 1st year remain simiar to those observed on discharge but they decrease markedly thereafter. Children who suffer from PEM before the age of 2 have a decreased chance of survival the risk of death being particularly high during the 1st year of discharge.
INTRODUCTION Burundi introduced free healthcare for children under five and pregnant women in 200... more INTRODUCTION Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, this was linked to the Performance-Based Financing (PBF) approach. This article is designed to identify factors in these health financing reforms that have contributed to good governance in the health sector. METHODS Six criteria of good governance were used as an analytical framework. Results were derived from official reports and the international literature. RESULTS The main contributions of these reforms to good governance in Burundi were the separation of functions, transparency in management and a meticulous description of administrative procedures. Scrupulous monitoring resulted in several corrective measures. DISCUSSION Several unresolved questions remain, concerning the integration of vertical programmes and the sustainability of the system given the considerable costs, since funding is not yet fully ensured by the State and its partners.
This paper compares the results of two SBBN codes developped independently by different teams of ... more This paper compares the results of two SBBN codes developped independently by different teams of physicists. These two codes have significant differences that lead to a discrepency between their final mass fractions of 4 He of 0.003. This paper shows that the mass fractions of each code had different orders of convergence, and how the number of timesteps affects the accuracy of the mass fractions. At the end, the paper shows how to modify both codes so that their 4 He mass fractions agree to around 0.0001.
Background Performance-based financing (PBF) is an increasingly adopted strategy in lowand middle... more Background Performance-based financing (PBF) is an increasingly adopted strategy in lowand middle-income countries. PBF pilot projects started in Burundi in 2006, at the same time when a national policy removed user fees for pregnant women and children below 5 years old. PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services. PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P < 0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time. The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explanation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.
objective Community participation is often described as a key for primary health care in lowincom... more objective Community participation is often described as a key for primary health care in lowincome countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance. method We evaluated 100 health committees and 79 CBOs using original data collected in six Burundi provinces (2009)(2010) and a framework based on the literature on community participation in health and New Institutional Economics. results Health committees appear to be rather ineffective, focusing on supporting the medical staff and not on representing the population. CBOs do convey information about the concerns of the population to the health authorities; yet, they represent only a few users and lack the ability to force changes. PBF does not automatically imply more 'voice' from the population, but introduces an interesting complement to health committees with CBOs. However, important efforts remain necessary to make both mechanisms work. More experiments and analysis are needed to develop truly efficient 'downward' mechanisms of accountability at the HC level. keywords community participation, performance-based financing, primary health care, health systems, rural health centres, Burundi
In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric ma... more In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.
To strengthen the health care delivery, the Burundian Government in collaboration with internatio... more To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned -by using a simple matching method -to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care.
Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, t... more Burundi introduced free healthcare for children under five and pregnant women in 2006. In 2010, this was linked to the Performance-Based Financing (PBF) approach. This article is designed to identify factors in these health financing reforms that have contributed to good governance in the health sector. Six criteria of good governance were used as an analytical framework. Results were derived from official reports and the international literature. The main contributions of these reforms to good governance in Burundi were the separation of functions, transparency in management and a meticulous description of administrative procedures. Scrupulous monitoring resulted in several corrective measures. Several unresolved questions remain, concerning the integration of vertical programmes and the sustainability of the system given the considerable costs, since funding is not yet fully ensured by the State and its partners.
Background: Performance-based financing (PBF) is an increasingly adopted strategy in low- and mid... more Background: Performance-based financing (PBF) is an increasingly adopted strategy in low- and middle-income countries. PBF pilot projects started in Burundi in 2006, at the same time when a national policy removed user fees for pregnant women and children below 5 years old.
Methods: PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services.
Results: PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P<0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time.
Discussion: The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explan- ation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.
objective Community participation is often described as a key for primary health care in lowincom... more objective Community participation is often described as a key for primary health care in lowincome countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance.
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Papers by Michel Bossuyt
Methods: PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services.
Results: PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P<0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time.
Discussion: The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explan- ation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.
Methods: PBF was gradually extended to the 17 provinces of the country. This roll-out and data from the national health information system are exploited to assess the impact of PBF on the use of health-care services.
Results: PBF is associated with an increase in the number of anti-tetanus vaccination of pregnant women (around þ20 percentage points in target population, P<0.10). Non-robust positive effects are also found on institutional deliveries and prenatal consultations. Changes in outpatient visits, postnatal visits and children vaccinations are not significantly correlated with PBF. It is also found that more qualified nurses headed to PBF-supported provinces. The limited quality of the data and the restricted size of the sample have to be taken into account when interpreting these results. Health facility-level figures from PBF-supported provinces show that most indicators but those relative to preventive care are growing through time.
Discussion: The dataset does not include indicators of the quality of care and does not allow to assess whether changes associated with PBF are resource-driven or due to the incentive mechanism itself. The results are largely consistent with other impact evaluations conducted in Burundi and Rwanda. The fact that PBF is mostly associated with positive changes in the use of services that became free suggests an important interaction effect between the two strategies. A possible explan- ation is that the removal of user fees increases accessibility to health care and acts on the demand side while PBF gives medical staffs incentives for improving the provision of services. More empirical research is needed to understand the sustainability of (the incentive mechanism of) PBF and the interaction between PBF and other health policies.