Exploring implementation practices in results-based financing: the case of the verification in Benin
Exploring implementation practices in results-based financing: the case of the verification in Benin
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DOI：
10.1186/s12913-017-2148-9
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发表时间：
2017-03-14
影响因子：
2.8
通讯作者：
Barthes, Olivier
中科院分区：
文献类型：
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作者：
Antony, Matthieu;Bertone, Maria Paola;Barthes, Olivier
背景资料：非洲许多国家都采用了基于成果的筹资办法，关于其影响评估的文献越来越多。这些研究通常是定量的，往往对取得成果的途径和过程以及RBF对更广泛的卫生系统的影响保持沉默。为了解决这一差距，我们的研究旨在探讨在贝宁的RBF试点的实施，侧重于验证的result.Methods：这项研究是基于行动研究的作者参与试点的一部分，该机构支持在贝宁的RBF实施。虽然我们的参与者观察和与项目利益相关者的业务合作为研究提供了信息，但分析主要基于在项目实施和文件编制过程中收集的定量和定性二级数据。数据包括项目文件，报告和预算，RBF数据的服务产出和验证的结果，在地区的技术助理，以及与社区为基础的组织和非正式访谈的焦点小组的日常活动时间表技术助理和地区医疗officers.Results：我们的分析侧重于定量，定性和社区核查的实际做法。结果表明，核查过程复杂、费用高、耗时长，而且在实践中，它们最终与最初的设计不同。我们探讨这对该计划的运作，其潜力，以产生预期的变化的后果。例如，我们发现，核查程序所占用的时间限制了数据分析和向设施工作人员反馈的时间，从而限制了改善服务的潜力。验证挑战还导致奖金支付延迟，这使努力和奖励脱钩。此外，有限的整合验证活动的地区团队与他们的日常任务造成进一步垂直化的卫生system.Conclusions：我们的研究结果突出了潜在的脱节背后的RBF和实际计划的实施理论的变化。的影响是相关的方法层面，强调分析实施过程的重要性，以充分了解结果，以及在业务层面，指出需要仔细调整的设计RBF计划（包括核查和其他关键功能）的背景下，并允许空间迭代修改它在实施过程中。他们还质疑进行彻底和昂贵的核查的理由是否合理，或者说是否有可能进行调整。
Background: Results-based financing (RBF) has been introduced in many countries across Africa and a growing literature is building around the assessment of their impact. These studies are usually quantitative and often silent on the paths and processes through which results are achieved and on the wider health system effects of RBF. To address this gap, our study aims at exploring the implementation of an RBF pilot in Benin, focusing on the verification of results.Methods: The study is based on action research carried out by authors involved in the pilot as part of the agency supporting the RBF implementation in Benin. While our participant observation and operational collaboration with project's stakeholders informed the study, the analysis is mostly based on quantitative and qualitative secondary data, collected throughout the project's implementation and documentation processes. Data include project documents, reports and budgets, RBF data on service outputs and on the outcome of the verification, daily activity timesheets of the technical assistants in the districts, as well as focus groups with Community-based Organizations and informal interviews with technical assistants and district medical officers.Results: Our analysis focuses on the actual practices of quantitative, qualitative and community verification. Results show that the verification processes are complex, costly and time-consuming, and in practice they end up differing from what designed originally. We explore the consequences of this on the operation of the scheme, on its potential to generate the envisaged change. We find, for example, that the time taken up by verification procedures limits the time available for data analysis and feedback to facility staff, thus limiting the potential to improve service delivery. Verification challenges also result in delays in bonus payment, which delink effort and reward. Additionally, the limited integration of the verification activities of district teams with their routine tasks causes a further verticalization of the health system.Conclusions: Our results highlight the potential disconnect between the theory of change behind RBF and the actual scheme's implementation. The implications are relevant at methodological level, stressing the importance of analyzing implementation processes to fully understand results, as well as at operational level, pointing to the need to carefully adapt the design of RBF schemes (including verification and other key functions) to the context and to allow room to iteratively modify it during implementation. They also question whether the rationale for thorough and costly verification is justified, or rather adaptations are possible.