Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe.
Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe.
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基于成果的融资能否改善资源匮乏环境中的卫生成果？津巴布韦的证据。
DOI：
10.1016/j.socscimed.2021.113959
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Borghi J
中科院分区：
文献类型：
--
作者：
Fichera E;Anselmi L;Gwati G;Brown G;Kovacs R;Borghi J
在低收入和中等收入国家的卫生系统中实施了基于结果的筹资，目的是改善人口健康。大多数对RBF计划的评价都侧重于激励服务的平均方案效果。关于RBF对健康结果的潜在影响以及对社会经济群体和时间段的异质性影响的证据有限。这项研究分析了津巴布韦国家RBF计划对新生儿，婴儿和五岁以下死亡率的影响，使用2005年，2010年和2015年的人口与健康调查数据。我们使用差异设计中的差异，它利用了该计划在60个地区的交错推出。我们检查平均方案的影响，并进行分组分析，以评估社会经济群体之间的差异。我们发现，RBF总体上将五岁以下儿童死亡率降低了两个百分点，但这种下降仅对财富高于中位数（2.7个百分点）和教育程度高于中位数（2.1个百分点）的母亲的孩子有意义。国家康复基金将机构服务提供率提高了7个百分点-对社会经济贫困群体和受教育程度最低的群体产生了统计上的显著影响。我们还发现RBF将剖腹产率降低了三个百分点。我们没有发现RBF对其他激励服务的影响。当考虑随着时间的推移方案的影响，我们发现，效果只观察到在第二阶段的方案（2012年3月），除了剖腹产，这只是减少在较长的时间。需要进一步的研究来检查这些发现是否可以推广到其他环境。津巴布韦的国家成果筹资计划降低了五岁以下儿童的死亡率。在高财富和高教育群体中。斐济储备银行增加了最贫穷和受教育程度最低群体的住院分娩，并降低了剖腹产率。对其他激励服务没有方案影响。在执行过程的早期，RBF方案的效果一般较强。
Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyses the effect of Zimbabwe's national RBF scheme on neonatal, infant and under five mortality, using Demographic and Health Survey data from 2005, 2010 and 2015. We use a difference in differences design, which exploits the staggered roll-out of the scheme across 60 districts. We examine average programme effects and perform sub-group analyses to assess differences between socio-economic groups. We find that RBF reduced under-five mortality by two percentage points overall, but that this decrease was only significant for children of mothers with above median wealth (2.7 percentage points) and education (2.1 percentage points). RBF increased institutional delivery by seven percentage points – with a statistically significant effect for poorer socio-economic groups and least educated. We also find that RBF reduced c-section rates by three percentage points. We find no detectable effect of RBF on other incentivised services. When considering programme effects over time, we find that effects were only observed during the second phase of the programme (March 2012) with the exception of c-sections, which only reduced in the longer term. Further research is needed to examine whether these findings can be generalised to other settings. Zimbabwe's national Results Based Financing scheme decreased under-five mortality. Among higher wealth and education groups. RBF increased institutional deliveries in the poorest and least educated groups and reduced the rate of c-section. There were no programme effects on other incentivised services. The RBF programme effects generally appear to be stronger earlier in the implementation process.
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DOI：
10.1186/s13012-016-0540-1
发表时间：
2017-02-02
期刊：
Implementation science : IS
影响因子：
--
作者：
Anselmi L;Binyaruka P;Borghi J
通讯作者：
Borghi J
影响因子：
3.2
作者：
Peabody, John W.;Shimkhada, Riti;McCulloch, Charles
通讯作者：
McCulloch, Charles
影响因子：
2.7
作者：
Lannes, Laurence;Meessen, Bruno;Basinga, Paulin
通讯作者：
Basinga, Paulin
影响因子：
1.4
作者：
Kadungure, Artwell;Brown, Garrett Wallace;Gwati, Gwati
通讯作者：
Gwati, Gwati
影响因子：
4.5
作者：
Das A;Gopalan SS;Chandramohan D
通讯作者：
Chandramohan D