Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
Vaccine. 2020 Feb 24;38(9):2209-2215. doi: 10.1016/j.vaccine.2020.01.033. Epub 2020 Jan 23.
Vaccination is known to be one of the most cost-effective ways to avert child deaths. However, in Nigeria, the vaccination completion rate among children is extremely low and the child mortality rate is one of the highest in the world. National immunization coverage survey shows that the low vaccination rate in Nigeria is partly attributed to service delivery issues. This paper evaluates the effect of Performance-Based Financing (PBF), an incentive scheme where health facilities are funded based on their performance, on the quantity of vaccinations carried out in Adamawa state. Under the Nigeria State Health Investment Project (NSHIP), half of the Local Government Areas (LGAs) in Adamawa State were randomly assigned to receive PBF intervention between 2015 and 2018. The Difference-in-Differences (DiD) technique as well as ANCOVA analysis are used to evaluate the effect of PBF on vaccination service delivery indicators. We find that the PBF intervention significantly increased the quantity of full vaccination cases as compared to the comparison group, although the effect size was small. On the other hand, if health facilities receive intensified PEI (Polio Eradication Initiative) concurrently, the effectiveness of PBF in increasing the number of full vaccination cases do not differ significantly from health facilities that are not under PBF. Rather than providing conditional financial incentives such as PBF to health facilities, simply providing unconditional financial and technical assistance to strengthen routine immunization programs might be sufficient to increase the quantity of vaccination service provision. The positive effect of PBF on vaccination provision was not sustainable, either. Future work should explore how we can strengthen the health system in a cost-effective and sustainable way.
接种疫苗被认为是避免儿童死亡的最具成本效益的方法之一。然而，在尼日利亚，儿童的疫苗接种完成率极低，儿童死亡率是世界上最高的之一。国家免疫覆盖调查显示，尼日利亚疫苗接种率低的部分原因是服务提供问题。本文评估了绩效为基础的融资（PBF）的效果，这是一种根据绩效为卫生机构提供资金的激励计划，对在阿达马瓦州进行的疫苗接种数量的影响。在尼日利亚州卫生投资项目（NSHIP）下，2015 年至 2018 年间，阿达马瓦州一半的地方政府区（LGA）被随机分配接受 PBF 干预。使用差异（DID）技术和协方差分析（ANCOVA）来评估 PBF 对疫苗接种服务提供指标的影响。我们发现，与对照组相比，PBF 干预显著增加了完全接种疫苗的病例数量，尽管效果较小。另一方面，如果卫生机构同时接受强化强化免疫规划（PEI），则 PBF 增加完全接种疫苗病例数量的效果与未接受 PBF 的卫生机构没有显著差异。与其向卫生机构提供有条件的财务激励，如 PBF，简单地提供无条件的财务和技术援助以加强常规免疫规划可能足以增加疫苗接种服务的提供量。PBF 对疫苗接种提供的积极影响也不是可持续的。未来的工作应该探讨如何以具有成本效益和可持续的方式加强卫生系统。
