Publication: Looking into the Performance-Based Financing Black Box: Evidence from an Impact Evaluation in the Health Sector in Cameroon
Date
2017-08
ISSN
Published
2017-08
Author(s)
Abstract
Performance-based financing is a complex
health system intervention aimed at improving coverage and
quality of care. This paper presents the results of an
impact evaluation in Cameroon that seeks to isolate the role
of specific components of the performance-based financing
approach on outcomes of interest, such as explicit financial
incentives linked to results, additional resources available
at the point of service delivery (not linked to
performance), and enhanced supervision, coaching, and
monitoring. Four evaluation groups were established to
measure the effects of each component that was studied. In
general, the results indicate that performance-based
financing in Cameroon is an efficient mechanism to channel
payments and funding to the provider level, leading to
significant increases in utilization in the
performance-based financing arm for several services (child
and maternal vaccinations and use of modern family
planning), but not for others, such as antenatal care visits
and facility-based deliveries. However, for many of those
outcomes, the differences between the performance-based
financing group and the additional financing group are not
significant. In terms of quality, performance-based
financing was found to have a significant impact on the
availability of essential inputs and equipment, qualified
health workers, reduction in formal and informal user fees,
and increased satisfaction among patients and providers.
However, there was a clear effect of additional financing,
irrespective of whether it was linked to incentives, in
combination with reinforced supervision through
performance-based financing. This result suggests that
enhanced supervision and monitoring on their own are not
sufficient to improve maternal and child health outcomes.
Citation
“de Walque, Damien; Robyn, Paul Jacob; Saidou, Hamadou; Sorgho, Gaston; Steenland, Maria. 2017. Looking into the Performance-Based Financing Black Box: Evidence from an Impact Evaluation in the Health Sector in Cameroon. Policy Research Working Paper;No. 8162. © World Bank, Washington, DC. http://hdl.handle.net/10986/27969 License: CC BY 3.0 IGO.”
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