Looking into the performance-based financing black box: evidence from an impact evaluation in the health sector in Cameroon.

Health Policy and Planning
Damien de WalqueMaria Steenland

Abstract

Performance-based financing (PBF) is a complex health systems intervention aimed at improving the coverage and quality of care. Several studies have shown a positive impact of PBF on health service coverage, often coupled with improvements in quality, but relatively little is known about the mechanisms driving those results. This article presents results of a randomized impact evaluation in Cameroon designed to isolate the role of specific components of the PBF approach with four study groups: (i) PBF with explicit financial incentives linked to results, (ii) direct financing with additional resources available for health providers not linked to performance, (iii) enhanced supervision and monitoring without additional resources and (iv) a control group. Overall, results indicate that, when compared with the pure control group, PBF in Cameroon led to significant increases in utilization for several services (child and maternal vaccinations, use of modern family planning), but not for others like antenatal care visits and facility-based deliveries. In terms of quality, PBF increased the availability of inputs and equipment, qualified health workers, led to a reduction in formal and informal user fees but did not affect the conten...Continue Reading

References

Apr 1, 2008·The Journal of Economic Perspectives : a Journal of the American Economic Association·Jishnu DasKenneth Leonard
Oct 31, 2012·Health Policy and Planning·Wu ZengDonald S Shepard
Mar 2, 2017·Human Resources for Health·Gordon C ShenJed Friedman

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