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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Date
2019
Authors
Lubumbashi, Emmanuel Chileshe
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
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.
Description
Thesis
Keywords
Maternal health services--Zambia , Result-based financing--Maternal health services--Zambia