柬埔寨农村地区基于绩效的融资与全球疫苗免疫联盟卫生系统强化资金投入：影响简要评估

Performance-based financing with GAVI health system strengthening funding in rural Cambodia: a brief assessment of the impact.

作者信息

Matsuoka Sadatoshi, Obara Hiromi, Nagai Mari, Murakami Hitoshi, Chan Lon Rasmey

机构信息

TAC International Inc., 1010, 8-15-10, Ginza, Chuo-ku, Tokyo 104-0061, Japan, JICA (Japan International Cooperation Agency) Project for Improving Maternal, Newborn and Child Health in the Lagos State, Block 4, Room 407, The Secretariat Obafemi Awolowo Way, Alausa, Ikeja, Lagos State, Nigeria, Department of International Cooperation, National Center for Global Health and Medicine, 1-32-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan, Kampong Cham Provincial Health Department, Ministry of Health, P.O. Box 0333, Kampong Cham, CambodiaTAC International Inc., 1010, 8-15-10, Ginza, Chuo-ku, Tokyo 104-0061, Japan, JICA (Japan International Cooperation Agency) Project for Improving Maternal, Newborn and Child Health in the Lagos State, Block 4, Room 407, The Secretariat Obafemi Awolowo Way, Alausa, Ikeja, Lagos State, Nigeria, Department of International Cooperation, National Center for Global Health and Medicine, 1-32-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan, Kampong Cham Provincial Health Department, Ministry of Health, P.O. Box 0333, Kampong Cham, Cambodia

出版信息

Health Policy Plan. 2014 Jul;29(4):456-65. doi: 10.1093/heapol/czt030. Epub 2013 Jun 3.

DOI:10.1093/heapol/czt030

PMID:23735736

Abstract

INTRODUCTION

Though Cambodia made impressive gains in immunization coverage between the years 2000 and 2005, it recognized several health system challenges to greater coverage of immunization and sustainability. The Global Alliance for Vaccines and Immunization (GAVI) opened a Health System Strengthening (HSS) funding window in 2006. To address the health system challenges, Cambodia has been receiving the GAVI HSS fund since October 2007. The major component of the support is performance-based financing (PBF) for maternal, neonatal and child health (MNCH) services.

OBJECTIVE

To examine the impact of the PBF scheme on MNCH services and administrative management in rural Cambodia.

METHODS

Quantitative and qualitative studies were conducted in Kroch Chhmar Operational District (OD), Cambodia. Quantitative analyses were conducted on the trends of the numbers of MNCH services. A brief analysis was conducted using qualitative data.

RESULTS

After the commencement of the PBF support, the volume of MNCH services was significantly boosted. In addition, strengthened financial and operational management was observed in the study area. However, the quality of the MNCH services was not ensured. Technical assistance, rather than the PBF scheme, was perceived by stakeholders to play a vital role in increasing the quality of the services.

DISCUSSION

To improve the quality of the health services provided, it is better to include indicators on the quality of care in the PBF scheme. Mutual co-operation between PBF models and technical assistance may ensure better service quality while boosting the quantity. A robust but feasible data validation mechanism should be in place, as a PBF could incentivize inaccurate reporting. The capacity for financial management should be strengthened in PBF recipient ODs. To address the broader aspects of MNCH, a balanced input of resources and strengthening of all six building blocks of a health system are necessary.

摘要

引言

尽管柬埔寨在2000年至2005年间免疫接种覆盖率取得了令人瞩目的增长，但该国认识到在扩大免疫接种覆盖率和可持续性方面存在若干卫生系统挑战。全球疫苗免疫联盟（GAVI）于2006年开设了一个卫生系统加强（HSS）资金窗口。为应对卫生系统挑战，柬埔寨自2007年10月起开始接受GAVI HSS基金。支持的主要组成部分是针对孕产妇、新生儿和儿童健康（MNCH）服务的基于绩效的融资（PBF）。

目的

研究PBF计划对柬埔寨农村地区MNCH服务和行政管理的影响。

方法

在柬埔寨的克罗奇·奇马尔运营区（OD）进行了定量和定性研究。对MNCH服务数量的趋势进行了定量分析。使用定性数据进行了简要分析。

结果

PBF支持开始后，MNCH服务量显著增加。此外，研究区域的财务和运营管理得到加强。然而，MNCH服务的质量并未得到保证。利益相关者认为技术援助而非PBF计划在提高服务质量方面发挥了至关重要的作用。

讨论

为提高所提供卫生服务的质量，最好在PBF计划中纳入护理质量指标。PBF模式与技术援助之间的相互合作可能在增加服务数量的同时确保更好的服务质量。应建立一个强大但可行的数据验证机制，因为PBF可能会激励不准确的报告。应加强PBF受援OD的财务管理能力。为解决MNCH的更广泛问题，有必要平衡资源投入并加强卫生系统的所有六个组成部分。