Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon

Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechani...

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Main Authors:	de Walque, Damien, Robyn, Paul Jacob, Saidou, Hamadou, Sorgho, Gaston, Steenland, Maria
Format:	Journal Article
Published:	Oxford University Press 2022
Subjects:	PERFORMANCE-BASED FINANCING QUALITY OF HEALTH CARE FAMILY PLANNING HEALTH SERVICE DELIVERY HEALTH CARE SYSTEM FINANCIAL INCENTIVE PRENATAL CARE VACCINATION HEALTH FINANCING
Online Access:	http://hdl.handle.net/10986/37001

id	okr-10986-37001
recordtype	oai_dc
spelling	okr-10986-370012022-02-19T05:10:38Z Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon de Walque, Damien Robyn, Paul Jacob Saidou, Hamadou Sorgho, Gaston Steenland, Maria PERFORMANCE-BASED FINANCING QUALITY OF HEALTH CARE FAMILY PLANNING HEALTH SERVICE DELIVERY HEALTH CARE SYSTEM FINANCIAL INCENTIVE PRENATAL CARE VACCINATION HEALTH FINANCING Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechanisms driving those results. This article presents results of a randomized impact evaluation in Cameroon designed to isolate the role of specific components of the PBF approach with four study groups: (i) PBF with explicit financial incentives linked to results, (ii) direct financing with additional resources available for health providers not linked to performance, (iii) enhanced supervision and monitoring without additional resources and (iv) a control group. Overall, results indicate that, when compared with the pure control group, PBF in Cameroon led to significant increases in utilization for several services (child and maternal vaccinations, use of modern family planning), but not for others like antenatal care visits and facility-based deliveries. In terms of quality, PBF increased the availability of inputs and equipment, qualified health workers, led to a reduction in formal and informal user fees but did not affect the content of care. However, for many positively impacted outcomes, the differences between the PBF group and the group receiving additional financing not linked to performance are not significant, suggesting that additional funding rather than the explicit incentives might be driving improvements. In contrast, the intervention group offering enhanced supervision, coaching and monitoring without additional funding did not experience significant impacts compared to the control group. 2022-02-18T17:36:45Z 2022-02-18T17:36:45Z 2021-07 Journal Article Health Policy and Planning 1460-2237 http://hdl.handle.net/10986/37001 CC BY-NC-ND 3.0 IGO http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Oxford University Press Publications & Research :: Journal Article Africa Africa Eastern and Southern (AFE) Africa Western and Central (AFW) Africa Cameroon
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
topic	PERFORMANCE-BASED FINANCING QUALITY OF HEALTH CARE FAMILY PLANNING HEALTH SERVICE DELIVERY HEALTH CARE SYSTEM FINANCIAL INCENTIVE PRENATAL CARE VACCINATION HEALTH FINANCING
spellingShingle	PERFORMANCE-BASED FINANCING QUALITY OF HEALTH CARE FAMILY PLANNING HEALTH SERVICE DELIVERY HEALTH CARE SYSTEM FINANCIAL INCENTIVE PRENATAL CARE VACCINATION HEALTH FINANCING de Walque, Damien Robyn, Paul Jacob Saidou, Hamadou Sorgho, Gaston Steenland, Maria Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
geographic_facet	Africa Africa Eastern and Southern (AFE) Africa Western and Central (AFW) Africa Cameroon
description	Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechanisms driving those results. This article presents results of a randomized impact evaluation in Cameroon designed to isolate the role of specific components of the PBF approach with four study groups: (i) PBF with explicit financial incentives linked to results, (ii) direct financing with additional resources available for health providers not linked to performance, (iii) enhanced supervision and monitoring without additional resources and (iv) a control group. Overall, results indicate that, when compared with the pure control group, PBF in Cameroon led to significant increases in utilization for several services (child and maternal vaccinations, use of modern family planning), but not for others like antenatal care visits and facility-based deliveries. In terms of quality, PBF increased the availability of inputs and equipment, qualified health workers, led to a reduction in formal and informal user fees but did not affect the content of care. However, for many positively impacted outcomes, the differences between the PBF group and the group receiving additional financing not linked to performance are not significant, suggesting that additional funding rather than the explicit incentives might be driving improvements. In contrast, the intervention group offering enhanced supervision, coaching and monitoring without additional funding did not experience significant impacts compared to the control group.
format	Journal Article
author	de Walque, Damien Robyn, Paul Jacob Saidou, Hamadou Sorgho, Gaston Steenland, Maria
author_facet	de Walque, Damien Robyn, Paul Jacob Saidou, Hamadou Sorgho, Gaston Steenland, Maria
author_sort	de Walque, Damien
title	Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
title_short	Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
title_full	Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
title_fullStr	Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
title_full_unstemmed	Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon
title_sort	looking into the performance-based financing black box : evidence from an impact evaluation in the health sector in cameroon
publisher	Oxford University Press
publishDate	2022
url	http://hdl.handle.net/10986/37001
_version_	1764486330048315392

Looking into the performance-based financing black box : Evidence from an impact evaluation in the health sector in Cameroon

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