Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi

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dc.contributor.author Brenner, Stephan
dc.contributor.author Mazalale, Jacob
dc.contributor.author Wilhelm, Danielle
dc.contributor.author Nesbitt, Robin C
dc.contributor.author Lohela, Terhi J
dc.contributor.author Chinkhumba, Jobiba
dc.contributor.author Lohmann, Julia
dc.contributor.author Muula, Adamson S
dc.contributor.author De Allegri, Manuela
dc.date.accessioned 2018-10-21T03:19:44Z
dc.date.available 2018-10-21T03:19:44Z
dc.date.issued 2018-10-19
dc.identifier.citation BMC Health Services Research. 2018 Oct 19;18(1):791
dc.identifier.uri http://hdl.handle.net/10138/252130
dc.description.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.
dc.publisher BioMed Central
dc.subject Results-based financing
dc.subject Effective coverage
dc.subject Maternal and child health
dc.subject Quality of care
dc.subject Health care financing
dc.title Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi
dc.date.updated 2018-10-21T03:19:44Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).
dc.type.uri http://purl.org/eprint/entityType/ScholarlyWork
dc.type.uri http://purl.org/eprint/entityType/Expression
dc.type.uri http://purl.org/eprint/type/JournalArticle

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