Chinkhumba Jobiba, De Allegri Manuela, Mazalale Jacob, Brenner Stephan, Mathanga Don, Muula Adamson S, Robberstad Bjarne
Department of Public Health, University of Malawi, College of Medicine, School of Public Health and Family Medicine, Blantyre, Malawi.
Center for international Health. University of Bergen, Bergen, Norway.
PLoS One. 2017 Sep 21;12(9):e0182326. doi: 10.1371/journal.pone.0182326. eCollection 2017.
Results-based financing (RBF) schemes-including performance based financing (PBF) and conditional cash transfers (CCT)-are increasingly being used to encourage use and improve quality of institutional health care for pregnant women in order to reduce maternal and neonatal mortality in low-income countries. While there is emerging evidence that RBF can increase service use and quality, little is known on the impact of RBF on costs and time to seek care for obstetric complications, although the two represent important dimensions of access. We conducted this study to fill the existing gap in knowledge by investigating the impact of RBF (PBF+CCT) on household costs and time to seek care for obstetric complications in four districts in Malawi. The analysis included data on 2,219 women with obstetric complications from three waves of a population-based survey conducted at baseline in 2013 and repeated in 2014(midline) and 2015(endline). Using a before and after approach with controls, we applied generalized linear models to study the association between RBF and household costs and time to seek care. Results indicated that receipt of RBF was associated with a significant reduction in the expected mean time to seek care for women experiencing an obstetric complication. Relative to non-RBF, time to seek care in RBF areas decreased by 27.3% (95%CI: 28.4-25.9) at midline and 34.2% (95%CI: 37.8-30.4) at endline. No substantial change in household costs was observed. We conclude that the reduced time to seek care is a manifestation of RBF induced quality improvements, prompting faster decisions on care seeking at household level. Our results suggest RBF may contribute to timely emergency care seeking and thus ultimately reduce maternal and neonatal mortality in beneficiary populations.
基于结果的融资（RBF）计划，包括基于绩效的融资（PBF）和有条件现金转移（CCT），正越来越多地被用于鼓励低收入国家的孕妇使用机构医疗保健并提高其质量，以降低孕产妇和新生儿死亡率。虽然有新证据表明RBF可以增加服务使用和提高质量，但对于RBF对产科并发症就医成本和时间的影响知之甚少，尽管这两者是就医机会的重要方面。我们开展这项研究，通过调查RBF（PBF + CCT）对马拉维四个地区家庭产科并发症就医成本和时间的影响，来填补现有知识空白。分析纳入了2013年基线、2014年（中期）和2015年（终期）开展的三轮基于人群的调查中2219名患有产科并发症妇女的数据。我们采用带对照的前后对比方法，应用广义线性模型研究RBF与家庭成本和就医时间之间的关联。结果表明，接受RBF与经历产科并发症妇女的预期平均就医时间显著减少有关。与非RBF地区相比，RBF地区的就医时间在中期减少了27.3%（95%CI：28.4 - 25.9），在终期减少了34.2%（95%CI：37.8 - 30.4）。未观察到家庭成本有实质性变化。我们得出结论，就医时间的减少是RBF促使质量改善的体现，促使家庭层面更快做出就医决策。我们的结果表明，RBF可能有助于及时寻求紧急医疗护理，从而最终降低受益人群的孕产妇和新生儿死亡率。
