Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, Gulshan 1, Dhaka, Bangladesh.
Health Policy. 2010 Jul;96(2):98-107. doi: 10.1016/j.healthpol.2010.01.008.
Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup.
Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts.
The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services.
The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health care services cannot be expected by the DSF mechanism alone within an environment lacking the pre-requirements for competition. Quality assurance mechanisms need to be put in place. A large-scale impact evaluation is currently underway.
需求方融资（DSF）机制将购买力转移给特定群体，用于特定的商品和服务，以增加对特定服务的获取。这是医疗保健系统中的一项重要创新，尽管对供应方进行了大量补贴，但获取服务的机会仍然很差。在孟加拉国，2007 年在 33 个分区启动了一项产妇保健 DSF 试点。我们报告了该计划在启动 1 年后于 2008 年进行的快速审查结果。
DSF 委员会、设施和国家信息系统收集的定量数据与定性数据一起评估，定性数据包括 6 个分区中受益人和卫生服务提供者对该计划运作的关键知情人访谈和焦点小组讨论。
该计划向卫生工作者分发凭证，主要使贫困妇女有权在家中或设施获得熟练护理，并为交通和食品提供付款。在最初的挫折之后，凭证的分发迅速增加。数据还表明，在 DSF 中，基于设施的分娩率上升似乎比其他非 DSF 地区更快，尽管这些方法不允许进行严格的因果归因，因为可能存在共同构成效应。有人担心，为剖腹产提供经济激励会导致过度强调剖腹产，但这些趋势需要进一步监测，这种担忧似乎没有根据。DSF 为设施提供了大量额外资金，但管理仍然很复杂，需要并行的行政机制，给卫生工作者增加了额外的工作负担。几乎没有证据表明，由于医疗保健服务的提供有限，该机制会鼓励竞争。
尚未解决的主要问题是，通过调整常规政府资金而不是创建全新机制，是否可以更有效地实现 DSF 计划的成果。此外，在缺乏竞争前要求的环境中，仅通过 DSF 机制无法提高医疗保健服务的质量。需要建立质量保证机制。目前正在进行一项大规模的影响评估。
