Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany.
Department of Gynecology and Obstetrics, Otto-Von-Guericke University, Magdeburg, Germany.
BMC Pregnancy Childbirth. 2023 May 15;23(1):352. doi: 10.1186/s12884-023-05573-x.
While maternal mortality has declined globally, it remains highest in low-income countries. High-quality antenatal care (ANC) can prevent or decrease pregnancy-related complications for mothers and newborns. The implementation of performance-based financing (PBF) schemes in Sub-Saharan Africa to improve primary healthcare provision commonly includes financial indicators linked to ANC service quality indicators. In this study, we examine changes in ANC provision produced by the introduction of a PBF scheme in rural Burkina Faso.
This study followed a quasi-experimental design with two data collection points comparing effects on ANC service quality between primary health facilities across intervention and control districts based on difference-in-differences estimates. Performance scores were defined using data on structural and process quality of care reflecting key clinical aspects of ANC provision related to screening and prevention pertaining to first and follow-up ANC visits.
We found a statistically significant increase in performance scores by 10 percent-points in facilities' readiness to provide ANC services. The clinical care provided to different ANC client groups scored generally low, especially with respect to preventive care measures, we failed to observe any substantial changes in the clinical provision of ANC care attributable to the PBF.
The observed effect pattern reflects the incentive structure implemented by the scheme, with a stronger focus on structural elements compared with clinical aspects of care. This limited the scheme's overall potential to improve ANC provision at the client level after the observed three-year implementation period. To improve both facility readiness and health worker performance, stronger incentives are needed to increase adherence to clinical standards and patient care outcomes.
尽管全球孕产妇死亡率有所下降，但在低收入国家仍然最高。高质量的产前护理（ANC）可以预防或减少母亲和新生儿与妊娠相关的并发症。在撒哈拉以南非洲实施绩效为基础的融资（PBF）计划以改善初级卫生保健服务通常包括与 ANC 服务质量指标相关的财务指标。在这项研究中，我们研究了在布基纳法索农村引入 PBF 计划对 ANC 提供情况的影响。
本研究采用准实验设计，在两个数据收集点比较了干预和对照地区的基层卫生保健机构之间 ANC 服务质量的影响，基于差异差异估计。绩效得分是根据反映 ANC 提供相关关键临床方面的护理结构和过程质量数据定义的，与筛查和预防有关的首次和随访 ANC 就诊。
我们发现 ANC 服务准备就绪的设施绩效得分增加了 10 个百分点，具有统计学意义。为不同 ANC 客户群体提供的临床护理总体得分较低，特别是在预防保健措施方面，我们没有观察到 PBF 归因于 ANC 护理临床提供的任何实质性变化。
观察到的效应模式反映了该计划实施的激励结构，与护理的临床方面相比，更侧重于结构要素。这限制了该计划在观察到的三年实施期后改善客户层面 ANC 提供的总体潜力。为了提高设施准备程度和卫生工作者的绩效，需要更强的激励措施来提高对临床标准和患者护理结果的遵守。
