Mussah V G, Mapleh L, Ade S, Harries A D, Bhat P, Kateh F, Dahn B
Performance-based Financing Unit, Department of Health Services (DHS), Ministry of Health (MoH), Monrovia, Liberia.
Fixed Amount Reimbursement Agreement Unit, DHS, MoH, Monrovia, Liberia.
Public Health Action. 2017 Jun 21;7(Suppl 1):S100-S105. doi: 10.5588/pha.16.0096.
The Liberian counties of Bong, with performance-based financing (PBF) for all 36 public primary-care facilities, and Margibi, with no PBF for its 24 public primary-care facilities. To compare whether specific maternal and child health indicators changed in the two counties during the pre-Ebola (2013), Ebola (2014) and post-Ebola (2015) disease outbreak periods from July to September each year. This was a cross-sectional study. For pregnant women, the numbers of antenatal visits, intermittent preventive malaria treatments, human immunodeficiency virus (HIV) tests and facility-based births with skilled attendants all fell during the Ebola period, with decreases being significantly more marked in Margibi County. Apart from HIV testing, which remained low in both counties, these indicators increased in the post-Ebola period, with increases significantly more marked in Bong than in Margibi. The number of childhood immunisations decreased significantly in Bong in the Ebola period compared with the pre-Ebola period, but increased to above pre-Ebola levels in the post-Ebola period. There were markedly larger decreases in childhood immunisations in Margibi County during the Ebola period, which remained significantly lower in the post-Ebola period compared with Bong County. In a PBF-supported county, selected maternal and childhood health indicators showed less deterioration during Ebola and better recovery post-Ebola than in a non-PBF-supported county.
利比里亚的邦县，其36所公立基层医疗设施采用基于绩效的融资（PBF）模式；还有马吉比县，其24所公立基层医疗设施未采用PBF模式。为比较在每年7月至9月的埃博拉疫情前（2013年）、埃博拉疫情期间（2014年）和埃博拉疫情后（2015年）这两个县特定的孕产妇和儿童健康指标是否发生了变化。这是一项横断面研究。对于孕妇而言，产前检查次数、间歇性预防疟疾治疗、人类免疫缺陷病毒（HIV）检测以及有熟练医护人员在场的机构分娩数量在埃博拉疫情期间均有所下降，在马吉比县下降更为显著。除了HIV检测在两个县的比例均较低外，这些指标在埃博拉疫情后有所上升，在邦县的上升幅度明显大于马吉比县。与埃博拉疫情前相比，邦县儿童免疫接种数量在埃博拉疫情期间显著下降，但在埃博拉疫情后增加到了疫情前水平之上。在埃博拉疫情期间，马吉比县儿童免疫接种数量的下降幅度明显更大，在埃博拉疫情后仍显著低于邦县。在一个采用PBF模式支持的县，与未采用PBF模式支持的县相比，选定的孕产妇和儿童健康指标在埃博拉疫情期间恶化程度较小，在埃博拉疫情后恢复情况更好。
