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

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http://hdl.handle.net/10138/273446

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Brenner , S , Mazalale , J , Wilhelm , D , Nesbitt , R C , Lohela , T J , Chinkhumba , J , Lohmann , J , Muula , A S & De Allegri , M 2018 , ' Impact of results-based financing on effective obstetric care coverage : evidence from a quasi-experimental study in Malawi ' , BMC Health Services Research , vol. 18 , 791 . https://doi.org/10.1186/s12913-018-3589-5

Title: Impact of results-based financing on effective obstetric care coverage : evidence from a quasi-experimental study in Malawi
Author: Brenner, Stephan; Mazalale, Jacob; Wilhelm, Danielle; Nesbitt, Robin C.; Lohela, Terhi J.; Chinkhumba, Jobiba; Lohmann, Julia; Muula, Adamson S.; De Allegri, Manuela
Contributor: University of Helsinki, Department of Public Health
Date: 2018-10-19
Language: eng
Number of pages: 10
Belongs to series: BMC Health Services Research
ISSN: 1472-6963
URI: http://hdl.handle.net/10138/273446
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.
Subject: Results-based financing
Effective coverage
Maternal and child health
Quality of care
Health care financing
HEALTH-CARE
PERFORMANCE
QUALITY
3141 Health care science
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