Gage Anna, Bauhoff Sebastian
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA.
Health Policy Plan. 2021 Apr 21;36(3):332-340. doi: 10.1093/heapol/czaa191.
Maternal and newborn care has been a primary focus of performance-based financing (PBF) projects, which have been piloted or implemented in 21 countries in sub-Saharan Africa since 2007. Several evaluations of PBF have demonstrated improvements to facility delivery or quality of care. However, no studies have measured the impact of PBF programmes directly on neonatal health outcomes in Africa, nor compared PBF programmes against another. We assess the impact of PBF on early neonatal health outcomes and associated health care utilization and quality in Burundi, Lesotho, Senegal, Zambia and Zimbabwe. We pooled Demographic and Health Surveys and Multiple Indicator Cluster Surveys and apply difference-in-differences analysis to estimate the effect of PBF projects supported by the World Bank on early neonatal mortality and low birthweight. We also assessed the effect of PBF on intermediate outputs that are frequently explicitly incentivized in PBF projects, including facility delivery and antenatal care utilization and quality, and caesarean section. Finally, we examined the impact among births to poor or high-risk women. We found no statistically significant impact of PBF on neonatal health outcomes, health care utilization or quality in a pooled sample. PBF was also not associated with better health outcomes in each country individually, though in some countries and among poor women PBF improved facility delivery, antenatal care utilization or antenatal care quality. There was no improvement on the health outcomes among poor or high-risk women in the five countries. PBF had no impact on early neonatal health outcomes in the five African countries studied and had limited and variable effects on the utilization and quality of neonatal health care. These findings suggest that there is a need for both a deeper assessment of PBF and for other strategies to make meaningful improvements to neonatal health outcomes.
孕产妇和新生儿护理一直是基于绩效的融资（PBF）项目的主要重点，自2007年以来，该项目已在撒哈拉以南非洲的21个国家进行了试点或实施。对PBF的多项评估表明，设施分娩或护理质量有所改善。然而，尚无研究直接衡量PBF项目对非洲新生儿健康结局的影响，也未将PBF项目相互比较。我们评估了PBF对布隆迪、莱索托、塞内加尔、赞比亚和津巴布韦早期新生儿健康结局以及相关医疗保健利用和质量的影响。我们汇总了人口与健康调查和多指标类集调查，并应用差分分析来估计世界银行支持的PBF项目对早期新生儿死亡率和低出生体重的影响。我们还评估了PBF对PBF项目中经常明确激励的中间产出的影响，包括设施分娩、产前护理利用和质量以及剖宫产。最后，我们研究了贫困或高危妇女分娩的影响。我们发现，在汇总样本中，PBF对新生儿健康结局、医疗保健利用或质量没有统计学上的显著影响。PBF在每个国家单独来看也与更好的健康结局无关，不过在一些国家以及贫困妇女中，PBF改善了设施分娩、产前护理利用或产前护理质量。五个国家中贫困或高危妇女的健康结局没有改善。PBF对所研究的五个非洲国家的早期新生儿健康结局没有影响，对新生儿医疗保健的利用和质量影响有限且各不相同。这些发现表明，需要对PBF进行更深入的评估，并需要其他策略来切实改善新生儿健康结局。
