Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.
Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.
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DOI：
10.1186/s12889-016-2982-4
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发表时间：
2016-04-14
影响因子：
4.5
通讯作者：
Chandramohan D
中科院分区：
文献类型：
--
作者：
Das A;Gopalan SS;Chandramohan D
目前正在几个中低收入国家测试卫生设施和提供者的按业绩付费机制，以改善孕产妇和儿童健康。本文回顾了P4P项目对中低收入国家妇幼保健质量影响的现有证据。根据注册方案对文献进行系统性综述。使用关键词孕产妇护理、护理质量、纳塔尔护理、产科和新生儿急诊护理（EmONC）和儿童护理检索MEDLINE、Web of Science和Embase。在检索到的4535条记录中，只有8篇论文符合纳入标准。令人感兴趣的主要成果是妇幼保健的质量，分为结构质量、过程质量和成果。通过定制的质量检查表评估了研究间的偏倚风险。在布隆迪、刚果民主共和国、埃及、菲律宾和卢旺达，有四项干预前后对照研究、三项随机分组对照试验和一项干预后比较P4P项目妇幼保健的病例对照研究。有一些证据表明，P4P仅对妇幼保健的过程质量有积极影响。这些研究没有评估P4P对分娩、EmONC、纳塔尔护理和5岁以下儿童护理的影响。有微弱的证据表明P4P对孕产妇和新生儿健康结果以及自付费用的积极影响。P4P程序对结构质量有一些负面影响。P4P能有效提高纳塔尔护理过程质量。然而，需要进一步的研究来了解P4P对妇幼保健的影响及其在中低收入国家的因果途径。PROSPERO注册号CRD 42014013077。
Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist. There were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P’s positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality. P4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P’s impact on MCH and their causal pathways in LMICs. PROSPERO registration number CRD42014013077.