In: BMC Health Services Research, 18 (2018), Nr. 791. pp. 1-10. ISSN 1472-6963

PDF, English Download (897kB) | Lizenz: Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi by Brenner, Stephan ; Mazalale, Jacob ; Wilhelm, Danielle ; Nesbitt, Robin C. ; Lohela, Terhi J. ; Chinkhumba, Jobiba ; Lohmann, Julia ; Muula, Adamson S. ; De Allegri, Manuela underlies the terms of Creative Commons Attribution 4.0

Abstract

Abstract: Background Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied.

Methods: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation.

Results: There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program’s potential to produce stronger effects.

Conclusion: The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.