Effects of Results-Based Financing on Patient Satisfaction in Afghanistan

<p>A Results-Based Financing (RBF) program has been implemented in Afghanistan since September 2010 to improve the quality of health care and increase the utilization of maternal and child health services. This PhD study examines the impact of RBF on patient satisfaction and on determinants of patient satisfaction at health facility level in Afghanistan. Determinants of patient satisfaction in the study refer to health provider performance, availability of medicines, vaccines, equipment, and physical appearance of health facilities. I used data collected from a panel of health facilities over a three-year period. The data consist of nearly 3000 patient observations and exit interviews. I included 112 health facilities in my study. These health facilities were part of the 428 health facilities which had been randomly assigned to treatment and control groups prior to the start of RBF in 2010. Financial incentives were distributed among health providers in the treatment facilities through four administration mechanisms: salary-based, task-based, equal-amount, and mixed-method. Follow-up surveys were conducted in 2011 and 2012 in the same 112 facilities, but for new cross-sections of patients and health providers. I analysed a range of patient satisfaction and patient satisfaction determinants measures using a regression-adjusted difference-in-differences estimation model. The results from this study show that after a period of two years, there was an increase of only 8 percentage points in the proportion of patients who were very satisfied with services as a whole. However, the effect was not statistically significant. Similarly, specific aspects of patient satisfaction were not significantly affected by the intervention. Likewise, RBF did not have any significant effect on health provider performance, on availability of medicines, vaccines, and equipment, and on physical appearance of health facilities over a two-year period. I also found no difference in RBF treatment effects by the different incentive administration mechanisms. My study provides evidence which suggests that paying monetary incentives alone may not have the impetus to improve health provider performance to the satisfaction of patients in a post conflict country. In such settings, RBF initiatives need to include both financial and non-financial incentives for health providers in order to achieve the intended objectives of quality of care and patient satisfaction. My study provides pragmatic recommendations aimed at holistic approaches to improving quality and delivery of healthcare in a post conflict setting.</p>

Effects of Results-Based Financing on Patient Satisfaction in Afghanistan

<p>A Results-Based Financing (RBF) program has been implemented in Afghanistan since September 2010 to improve the quality of health care and increase the utilization of maternal and child health services. This PhD study examines the impact of RBF on patient satisfaction and on determinants of patient satisfaction at health facility level in Afghanistan. Determinants of patient satisfaction in the study refer to health provider performance, availability of medicines, vaccines, equipment, and physical appearance of health facilities. I used data collected from a panel of health facilities over a three-year period. The data consist of nearly 3000 patient observations and exit interviews. I included 112 health facilities in my study. These health facilities were part of the 428 health facilities which had been randomly assigned to treatment and control groups prior to the start of RBF in 2010. Financial incentives were distributed among health providers in the treatment facilities through four administration mechanisms: salary-based, task-based, equal-amount, and mixed-method. Follow-up surveys were conducted in 2011 and 2012 in the same 112 facilities, but for new cross-sections of patients and health providers. I analysed a range of patient satisfaction and patient satisfaction determinants measures using a regression-adjusted difference-in-differences estimation model. The results from this study show that after a period of two years, there was an increase of only 8 percentage points in the proportion of patients who were very satisfied with services as a whole. However, the effect was not statistically significant. Similarly, specific aspects of patient satisfaction were not significantly affected by the intervention. Likewise, RBF did not have any significant effect on health provider performance, on availability of medicines, vaccines, and equipment, and on physical appearance of health facilities over a two-year period. I also found no difference in RBF treatment effects by the different incentive administration mechanisms. My study provides evidence which suggests that paying monetary incentives alone may not have the impetus to improve health provider performance to the satisfaction of patients in a post conflict country. In such settings, RBF initiatives need to include both financial and non-financial incentives for health providers in order to achieve the intended objectives of quality of care and patient satisfaction. My study provides pragmatic recommendations aimed at holistic approaches to improving quality and delivery of healthcare in a post conflict setting.</p>

Results-Based Financing (RBF) for Modern Energy Cooking Solutions: An Effective Driver for Innovation and Scale?

Results-based financing (RBF) programmes in the clean cooking sector have gained increasing donor interest over the last decade. Although the risks and advantages of RBF have been discussed quite extensively for other sectors, especially health services, there is limited research-documented experience of its application to clean cooking. Due to the sheer scale of the important transition from ‘dirty’ to clean cooking for the 4 billion people who lack access, especially in the Global South, efficient and performance-proven solutions are urgently required. This paper, undertaken as part of the work of the UKAid-funded Modern Energy Cooking Services (MECS) programme, aims to close an important research gap by reviewing evidence-based support mechanisms and documenting essential experiences from previous and ongoing RBF programmes in the clean cooking and other sectors. On this basis, the paper derives key strategic implications and learning lessons for the global scaling of RBF programmes and finds that qualitative key performance indicators such as consumer acceptance as well as longer-term monitoring are critical long-term success factors for RBF to ensure the continued uptake and use of clean cooking solutions (CCS), however securing the inclusion of these indicators within programmes remains challenging. Finally, by discussing the opportunities for the evolution of RBF into broader impact funding programmes and the integration of energy access and clean cooking strategies through multi-sector approaches, the paper illustrates potential steps to enhance the impact of RBF in this sector in the future.

Impact of a maternal and newborn health results-based financing intervention (RBF4MNH) on stillbirth: a cross-sectional comparison in four districts in Malawi

Background Malawi implemented a Results Based Financing (RBF) model for Maternal and Newborn Health, “RBF4MNH” at public hospitals in four Districts, with the aim of improving health outcomes. We used this context to seek evidence for the impact of this intervention on rates of antepartum and intrapartum stillbirth, taking women’s risk factors into account. Methods We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. We purposively selected two districts hosting the RBF4MNH intervention and two non-intervention districts for comparison. Data were extracted from the maternity registers and used to develop logistic regression models for variables associated with fresh and macerated stillbirth. Results We identified 67 stillbirths among 2772 deliveries representing 24.1 per 1000 live births of which 52% (n = 35) were fresh (intrapartum) stillbirths and 48% (n = 32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P = 0.01) and 7.27 (95%CI 2.74 to 19.25 P < 0.001) respectively. Among the risk factors examined, gestational age at delivery was significantly associated with increased odds of stillbirth. Conclusion The study did not identify a positive impact of this RBF model on the risk of fresh or macerated stillbirth. Within the scientific limitations of this non-randomised study using routinely collected health service data, the findings point to a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care, in order to reduce the burden of stillbirths.

Results Based Financing in Zambia: Performance Evaluation and Exploration of Opportunities in Health System Adoption

Background–Results Based Financing has strategically fit into discussions of the Universal Health Coverage agenda at global level with the aim of meeting the Sustainable Development Goals. It has been viewed that Results Based Financing is a potent financing model and can be used as a strategic tool for remodeling the health systems in many developing countries as suggested by prior studies which argued that Results Based Financing implementation requires: (i) a strong management support and political will; (ii) maximum innovative efficiencies and willingness for change; and (iii) strengthened health management information and reporting systems. Therefore, this study aimed at understanding how Results Based Financing approaches can be scaled-up by exploring the Successes, Challenges and Opportunities of adopting it into the health system from its project form.Methods -A case study design was used for this research with a quantitativedata collection approach. Data was analyzed using SPSS version 22.Results-The Results Based Financingprogramme improved all the indicators targeted in Lunte District Health facilities. The successes of the project included improved quality of health care services and strengthened health system. A notable challenge for Results BasedFinancing implementers was poor performance of non-incentivized indicators compared with the incentivized. However, an opportunity was seen with the project in that other financing models were discussed to either mimic or simply use Results Based Financing tools, pool funds in one basket and apply the concept. Results Based Financing improved efficiency and effectiveness based on results that health facilities learnt how to manage funds, shown by 67% of respondents, and commitment to re-investment 60% of their bonuses back into the system.Conclusion-Results based financing can be regarded as a model for harmonizing other donor funds and drive forward the financial sustainability of being a successful financing strategy for the health sector

Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe

PurposeThis study examines key adaptations that occurred in the Zimbabwean Results-Based Financing (RBF) programme between 2010 and 2017, locating the endogenous and exogenous factors that required adaptive response and the processes from which changes were made.Design/methodology/approachThe study is based on a desk review and thematic analysis of 64 policy and academic literatures supplemented with 28 multi-stakeholder interviews.FindingsThe programme experienced substantive adaption between 2010 and 2017, demonstrating a significant level of responsiveness towards increasing efficiency as well as to respond to unforeseen factors that undermined RBF mechanisms. The programme was adaptive due to its phased design, which allowed revision competencies and responsive adaptation, which provide useful insights for other low-and-middle income countries (LMICs) settings where graduated scale-up might better meet contextualised needs. However, exogenous factors were often not systematically examined or reported in RBF evaluations, demonstrating that adaptation could have been better anticipated, planned, reported and communicated, especially if RBF is to be a more effective health system reform tool.Originality/valueRBF is an increasingly popular health system reform tool in LMICs. However, there are questions about how exogenous factors affect RBF performance and acknowledgement that unforeseen endogenous programme design and implementation factors also greatly affect the performance of RBF. As a result, a better understanding of how RBF operates and adapts to programme level (endogenous) and exogenous (external) factors in LMICs is necessary.