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. 2017 Jan 10:3:179-184.
doi: 10.1016/j.ssmph.2017.01.001. eCollection 2017 Dec.

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Maria Steenland  1 , Paul Jacob Robyn  2 , Philippe Compaore  3 , Moussa Kabore  3 , Boukary Tapsoba  3 , Aloys Zongo  3 , Ousmane Diadie Haidara  4 , Günther Fink  1
Affiliations

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

Maria Steenland et al. SSM Popul Health. .

Abstract

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446-4.225]), 2.1 more deliveries (95% CI [0.034-4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.

Keywords: Burkina Faso; Health services; Performance-based financing; Provider incentives; Results-based financing.

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Figures

Fig. 1
Fig. 1
Intervention and comparison health facilities.
Fig. 2
Fig. 2
Number of 4th or 5th antenatal care visits performed by month in PBF and comparison districts, January 2009 – December 2012.
Fig. 3
Fig. 3
Proportion of monthly first ANC visits that occurred in the first trimester of pregnancy in PBF and comparison districts, January 2009 – December 2012.
Fig. 4
Fig. 4
Number of number of institutional deliveries performed by month in PBF and comparison districts, January 2009 – December 2012.
Fig. 5
Fig. 5
Number of postnatal care visits performed by month in PBF and comparison districts, January 2009 – December 2012.
See this image and copyright information in PMC

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