An evaluation of the effectiveness of results based financing on use of maternal and child health services. a case of Mafinga district of Zambia between 2015 – 2018

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Lubumbashi, Emmanuel Chileshe
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The University of Zambia
Result-based financing (RBF) is a pay-for-performance model where money or material goods are transferred on conditional to achieving a predetermined performance target. In healthcare RBF is an economic and financial incentive targeting increased use of health services and professional practice. Under the Zambia Health Systems Improvement Project, Mafinga district has been implementing RBF from 2016 to date (2018) in order to address challenges of health service delivery and supplement government’s traditional input-based funding. This study sought to assess the effectiveness of RBF intervention on use of health services and quality of health care in all Mafinga district. The study was conducted in Mafinga district on five (5) RBF implementing health facilities. A retrospective longitudinal study using quantitative methods was employed. Data was collected from the DHIMS from 1st quarter 2015 to 3nd quarter, 2018 using data collection forms on service indicators and checklist on quality improvement indicators. Microsoft excel and statistical package for the social sciences (SPSS) were used for analysis. Further, data was summarised using frequencies and proportions and Chi square test for trends was used to determine significance in trends before and after the RBF interventions. Measure of effectiveness in the study was adopted as the number of maternal and child health indicators showing positive and significant change upon inception of the RBF intervention. Also, positive improvement in quality of health services was used to measure effectiveness Study revealed that on average, use of MCH services declined from 50.6% in 2015 to 46.5% in 2016 before the intervention. However, after the intervention in 2017 average total use of MCH services increased to 60.9% and continued to increase to 70.6% in 2018. Study established positive maternal and child health increase after the intervention by 24.1%. However, the study found that the gains were not statistically significant at P-value of 0.78. Further the study compared the total average quality of health services before and after the intervention in 2016 and 2018 and found that in 2016 the average level of quality was at 71% and by 2018 increased to 84.9%. This marked a positive increase of 13.9% after RBF intervention. However, despite increase in quality of service after the intervention, the increase was not statistically significant at P-value of 0.87. Findings of the study showed that RBF made positive improvements on use of services and quality of health care in all health centres and hence the intervention was effective despite their not being statistical significance on positive improvements. In all, RBF advances for results and hence a better model to traditional financing subject to revision of operational modalities. Key terms: Results-based financing, Effectiveness of Intervention, Mother and Child health services, Quality of health services, Traditional Input-based financing.
Maternal health services--Zambia , Result-based financing--Maternal health services--Zambia