Schneider Institutes for Health Policy, Heller School, MS 035, Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA.
Formerly EPOS Health Management, Hindenburgring 18, 61348 Bad Homburg, Germany and.
Health Policy Plan. 2018 Apr 1;33(3):392-400. doi: 10.1093/heapol/czx195.
Results-based financing (RBF) has been advocated and increasingly scaled up in low- and middle-income countries to increase utilization and quality of key primary care services, thereby reducing maternal and child mortality rates. This pilot RBF study in the Republic of the Congo from 2012 to 2014 used a quasi-experimental research design. The authors conducted pre- and post-household surveys and gathered health facility services data from both intervention and comparison groups. Using a difference-in-differences approach, the study evaluated the impact of RBF on maternal and child health services. The household survey found statistically significant improvements in quality of services regarding the availability of medicines, perceived quality of care, hygiene of health facilities and being respected at the reception desk. The health facility survey showed no adverse effects and significantly favourable impacts on: curative visits, patient referral, children receiving vitamin A, HIV testing of pregnant women and assisted deliveries. These improvements, in relative terms, ranged from 42% (assisted deliveries) to 155% (children receiving vitamin A). However, the household survey found no statistically significant impacts on the five indicators measuring the use of maternal health services, including the percentage of pregnant women using prenatal care, 3+ prenatal care, postnatal care, assisted delivery, and family planning. Surprisingly, RBF was found to be associated with a reduction of coverage of the third diphtheria, pertussis, and tetanus immunization among children in the household survey. From the health facility survey, no association was found between RBF and full immunization among children. Overall, the study shows a favourable impact of an RBF programme on most, but not all, targeted maternal and child health services. Several aspects of programme implementation, such as timely disbursement of incentives, monitoring health facility performance, and transparency of using funds could be further strengthened to maximize RBF's impact.
基于成果的融资（RBF）已在中低收入国家得到倡导和推广，以提高关键初级保健服务的利用和质量，从而降低母婴死亡率。本研究是刚果共和国 2012 年至 2014 年进行的一项试点 RBF 研究，采用准实验研究设计。作者在干预组和对照组开展了住户调查，并收集了卫生机构服务数据。采用差分法，评估了 RBF 对母婴保健服务的影响。住户调查发现，在药品供应、护理质量感知、卫生机构卫生和在接待处受到尊重等方面，服务质量有了显著改善。卫生机构调查表明，RBF 对以下方面没有产生不利影响，反而具有显著有利影响：治疗性就诊、病人转诊、儿童接受维生素 A 治疗、孕妇艾滋病毒检测和辅助分娩。这些改善，相对而言，从 42%（辅助分娩）到 155%（儿童接受维生素 A）不等。然而，住户调查发现，RBF 对衡量孕产妇保健服务使用的五个指标没有产生统计学上的显著影响，包括接受产前保健的孕妇比例、产前保健 3 次以上、产后护理、辅助分娩和计划生育。令人惊讶的是，RBF 与住户调查中儿童第三剂白喉、百日咳和破伤风免疫接种覆盖率的下降有关。从卫生机构调查来看，RBF 与儿童全面免疫接种之间没有关联。总体而言，该研究表明，RBF 方案对大多数、但不是所有的目标母婴保健服务都产生了有利影响。方案实施的几个方面，如及时发放奖励、监测卫生机构绩效以及资金使用的透明度，可以进一步加强，以最大限度地发挥 RBF 的影响。
