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. 2018 Oct 19;18(1):791.
doi: 10.1186/s12913-018-3589-5.

Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi

Stephan Brenner  1 , Jacob Mazalale  2 , Danielle Wilhelm  3 , Robin C Nesbitt  3 , Terhi J Lohela  4 , Jobiba Chinkhumba  5 , Julia Lohmann  3 , Adamson S Muula  6 , Manuela De Allegri  3
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Impact of results-based financing on effective obstetric care coverage: evidence from a quasi-experimental study in Malawi

Stephan Brenner et al. BMC Health Serv Res. .

Abstract

Background: Results-based financing (RBF) describes health system approaches addressing both service quality and use. Effective coverage is a metric measuring progress towards universal health coverage (UHC). Although considered a means towards achieving UHC in settings with weak health financing modalities, the impact of RBF on effective coverage has not been explicitly studied.

Methods: Malawi introduced the Results-Based Financing For Maternal and Neonatal Health (RBF4MNH) Initiative in 2013 to improve quality of maternal and newborn health services at emergency obstetric care facilities. Using a quasi-experimental design, we examined the impact of the RBF4MNH on both crude and effective coverage of pregnant women across four districts during the two years following implementation.

Results: There was no effect on crude coverage. With a larger proportion of women in intervention areas receiving more effective care over time, the overall net increase in effective coverage was 7.1%-points (p = 0.07). The strongest impact on effective coverage (31.0%-point increase, p = 0.02) occurred only at lower cut-off level (60% of maximum score) of obstetric care effectiveness. Design-specific and wider health system factors likely limited the program's potential to produce stronger effects.

Conclusion: The RBF4MNH improved effective coverage of pregnant women and seems to be a promising reform approach towards reaching UHC. Given the short study period, the full potential of the current RBF scheme has likely not yet been reached.

Keywords: Effective coverage; Health care financing; Maternal and child health; Quality of care; Results-based financing.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the overall impact evaluation was obtained from the Ethical Committee of the Faculty of Medicine at the University of Heidelberg and from the College of Medicine Research and Ethics Committee (COMREC) at the University of Malawi. Free and informed written consent was obtained from all subjects involved in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Time trends of crude and effective coverage (without and with cut-off levels applied). Data based on descriptive non-adjusted analysis
See this image and copyright information in PMC

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