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Impacts of Performance‑Based Financing on Health System Performance: Evidence From The Democratic Republic of Congo (Published: 04 October 2023)

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dc.contributor.authorShapira, Gil
dc.contributor.authorBooto, Baudouin Makuma
dc.contributor.authorSamaha, Hadia
dc.contributor.authorFritsche, György Bèla
dc.contributor.authorMuvudi, Michel
dc.contributor.authorBaabo, Dominique
dc.contributor.authorAntwisi, Delphin
dc.contributor.authorRamanana, Didier
dc.contributor.authorBenami, Saloua
dc.contributor.authorFink, Günther
dc.date.accessioned2023-10-10T20:18:23Z
dc.date.available2023-10-10T20:18:23Z
dc.date.issued2023-10-10
dc.description.abstractHealth systems’ weakness remains one of the primary obstacles towards achieving universal access to quality healthcare in low-income settings. Performance-based financing (PBF) programs have been increasingly used to increase access to quality care in LMICs. However, evidence on the impacts of these programs remains fragmented and inconclusive. We analyze the health system impacts of the PBF program in the Democratic Republic of the Congo (DRC), one of the largest such programs introduced in LMICs to date. We used a health systems perspective to analyze the benefits of PBF relative to unconditional financing of health facilities. Fifty-eight health zones in six provinces were randomly assigned to either a control group (28 zones) in which facilities received unconditional transfers or to a PBF program (30 zones) that started at the end of 2016. Follow-up data collection took place in 2021–2022 and included health facility assessments, health worker interviews, direct observations of consultations and deliveries, patient exit interviews, and household surveys. Using multivariate regression models, we estimated the impact of the program on 55 outcomes in seven health system domains: structural quality, technical process quality, non-technical process quality, service fees, facility management, providers’ satisfaction, and service coverage. We used random-effects meta-analysis to generate pooled average estimates within each domain. The PBF program improved the structural quality of health facilities by 4 percentage points (ppts) (95% CI 0.01–0.08), technical process quality by 5 ppts (0.03–0.07), and non-technical process by 2 ppts (0–0.04). PBF also increased coverage of priority health services by 3 ppts (0.02–0.04). Improvements were also observed for facility management (9 ppts, 0.04–0.15), service fee policies, and users’ satisfaction with service affordability (14 ppts, 0.07–0.20). Service fees and health workers’ satisfaction were not affected by the program. The results suggest that well-designed PBF programs can lead to improvements in most health systems domains relative to comparable unconditional financing. However, the large persisting gaps suggest that additional changes, such as allocating more resources to the health system and reforming the human resources for health management, will be necessary in DRC to achieve the ambitious global universal health coverage and mortality goals.en
dc.identifier.citationBMC Medicine
dc.identifier.doi10.1596/40451
dc.identifier.issn1741-7015
dc.identifier.urihttps://openknowledge.worldbank.org/handle/10986/40451
dc.language.isoen_US
dc.publisherBMC Medicine
dc.rightsCC BY 4.0
dc.rights.holderWorld Bank
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectPERFORMANCE-BASED FINANCING
dc.subjectHEALTH SYSTEMS
dc.subjectQUALITY OF CARE
dc.subjectMATERNAL AND CHILD HEALTH
dc.titleImpacts of Performance‑Based Financing on Health System Performanceen
dc.title.subtitleEvidence From The Democratic Republic of Congo (Published: 04 October 2023)en
dc.typeJournal Article
dspace.entity.typePublication
okr.associatedcontenthttps://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03062-8 Version of Record
okr.crossref.titleImpacts of Performance‑Based Financing on Health System Performance: Evidence From The Democratic Republic of Congo (Published: 04 October 2023)
okr.date.disclosure2023-10-10
okr.doctypePublications & Research
okr.doctypePublications & Research::Journal Article
okr.externalcontentExternal Content
okr.guid099945010162321094
okr.identifier.doi10.1186/s12916-023-03062-8
okr.identifier.doihttp://dx.doi.org/10.1596/40451
okr.identifier.report185249
okr.language.supporteden
okr.peerreviewPeer Reviewed
okr.region.administrativeAfrica Western and Central (AFW)
okr.region.countryCongo, Democratic Republic of
okr.region.geographicalCentral Africa
okr.topicHealth, Nutrition and Population::Health Systems Development & Reform
okr.topicHealth, Nutrition and Population::Health Economics & Finance
okr.volume21 (381)
relation.isAuthorOfPublication41f6725d-021b-5878-8750-949260b0f2ca
relation.isAuthorOfPublication.latestForDiscovery41f6725d-021b-5878-8750-949260b0f2ca
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