Hagedorn Brittany, Cooper Jeremy, Loevinsohn Benjamin, Martufi Valentina
Institute for Disease Modeling, Gates Foundation, Seattle, USA.
Gavi The Vaccine Alliance, Geneva, Switzerland.
BMC Health Serv Res. 2025 Mar 18;25(1):394. doi: 10.1186/s12913-025-12512-3.
To improve service delivery of Nigeria's primary health care (PHC) system, the government tested two approaches for facility-level financing: performance-based financing (PBF) and decentralized facility financing (DFF). Facilities also had increased autonomy, supervision, and community oversight. We examine how the intervention approach and funding level affected breadth of services and structural quality.
We use health facility surveys previously collected in 2014 and 2017, covering three years of implementation, in which districts were randomly assigned PBF or DFF and compared to matched districts in control states. We use log-linear regressions and non-parametric statistics to estimate the effect size of the financing approach and level of funding per capita.
Service availability was highest in PBF facilities, while DFF also outperformed control on most measures. Results showed that structural readiness and service offerings both increased with more funding, especially under DFF. DFF and PBF facilities were better equipped to provide services that they claimed to offer, which was not the case for controls. Overall, PBF outperformed DFF, partially explained by funding levels. The rate of offering complimentary services followed a pattern of easiest-to-hardest to deliver.
PBF and DFF both improved the breadth and structural quality of services, although DFF performance was more sensitive to funding levels. Improvements were observed at relatively low levels of funding, but larger investments were associated with better performance. Most DFF facilities exceeded the performance of higher-funded controls, implying that funding was more valuable in the context of autonomy, increased supervision, and community oversight.
为改善尼日利亚初级卫生保健（PHC）系统的服务提供情况，政府对两种机构层面的融资方法进行了测试：基于绩效的融资（PBF）和分散式机构融资（DFF）。各机构在自主权、监督和社区监督方面也有所增强。我们研究了干预方法和资金水平如何影响服务广度和结构质量。
我们使用了2014年和2017年之前收集的卫生机构调查数据，涵盖三年的实施情况，其中各地区被随机分配接受PBF或DFF，并与对照州的匹配地区进行比较。我们使用对数线性回归和非参数统计来估计融资方法和人均资金水平的效应大小。
PBF机构的服务可及性最高，而DFF在大多数指标上也优于对照组。结果表明，结构准备情况和服务提供情况都随着资金增加而改善，特别是在DFF模式下。DFF和PBF机构更有能力提供它们声称能提供的服务，而对照组则不然。总体而言，PBF的表现优于DFF，部分原因是资金水平。提供免费服务的比例遵循从最容易提供到最难提供的模式。
PBF和DFF都改善了服务的广度和结构质量，尽管DFF的表现对资金水平更为敏感。在相对较低的资金水平下就观察到了改善，但更大的投资与更好的表现相关。大多数DFF机构的表现超过了资金更充足的对照组，这意味着在自主权增加、监督加强和社区监督的背景下，资金更有价值。
