Short Term Effects of Performance-Based Financing on Maternal and Child Health Services in the MIFI Health District

Background: Improving maternal, neonatal and child health are two of the most critical Sustainable Development Goals (MDGs). The Cameroon health system has consistently faced huge challenges to meet these objectives. As upshot; decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. In response; the performance- based financing (PBF) scheme was implemented. Objective of Study: Assess the short term effects of PBF on both maternal and child health services. Methods: An analytical cross-sectional study was carried out in the Mifi Health District to compare the trend in some key child health indicators before and after PBF’s implementation across 41 randomly selected health facilities. A linear regression model and a paired sample T-test were used in the analysis, considering a p-value of <0.05 as significant and a confidence interval at 95%. Results: There was a significant decrease in the mean Pentavalent dropout rate (p-value=0.02) as well as in the mean number of child deaths (p-value=0.019), per facilities per year from 26.61 and 0.46 before, to -104.07 and 0.15. There was also a significant increase in the proportion of women per facility per year who came for first antenatal care visit (ANC) p=0.001 from 94.55 before to 229.71 during PBF. The mean number per facility per year of pregnant women who attended at least 4 ANCs (p=0.034) also increased significantly from 44.65 before to 119.05 during PBF. Equally, the mean number of women per facility per year attending post natal visits significantly increased (p=0.010) from 23.23 before to 75.29 during PBF. Conclusion: The findings of the assessment of the effect of PBF scheme on maternal and child health services in the Mifi Health District, demonstrates a significant improvement in key indicators of maternal and child health, following PBF implementation. This study highlights the essential need for policymakers to carefully examine the effect of the PBF strategy on maternal and child health with the perspective of further scaling up this reform to other regions. Therefore, PBF can be an effective strategy for improving maternal and child health by increasing the utilisation of MCH services.

Transferring performance-based financing practices in Burundi health system: the role of actors’ interactions

Background: For the past twenty years, African countries have experienced a massive deployment of performance-based financing practices within health systems. These numerous transfers involved several actors of different profiles and who intervened at different levels. At a time when many actors in their diversity are playing key role in the success or failure of the transfer process, the role of actors’ interactions in the transfer process of performance-based financing practices remains however less explored in context and in depth. This paper aimed to explore the role of actors’ interactions in the deployment of this process within Burundi health system.Methods: We conducted a case study of the transfer of performance-based financing practices within Burundi health system. 32 semi-structured interviews were carried out in addition to documentary technique and observation. In a qualitative approach, our interpretive approach followed an abductive reasoning to interpret the data collected. Conceptualization using NVivo12 software allowed to perform thematic and content analysis.Results: We argued that the transfer setting, the organizational specifics, the nature of the transferred practices, the levels of operationalization and the actors’ perceptions are determining factors of the deployment of the transfer process of performance-based financing practices. Moreover, the actors’ interactions as well as their causes and their effects affect the deployment of the transfer process.Conclusions: The actors’ interactions are shown to play moderating and mediating roles in the process of transferring those practices. Future research could focus on verifying and validating this role with quantitative methods.