Impact of Performance-Based Financing on Health Facilities Performance in Family Planning

摘要

Toward the end of that scaling up of performance-based financing (PBF) started in Benin since 2015, it's important to realize whether the impacts in terms of performance improvement of health facilities (HFs) will still be confirmed or not, especially as far as family planning (FP) is concerned. A longitudinal retrospective study covered by the period of 14 quarters of a year (Q1 2014 to Q2 2017), was conducted including all public and private functional HFs of the two health district. The outcome variable (performance of HFs in FP) was the increase rates of new acceptance for any modern contraceptive method through the study period. The independent variables were the quality of the structure, the quality of the process and the context. A linear regression model was adjusted to find out the explanatory variable of the performance; the significance threshold was 5%. 55 HFs participated to the study. There was no improvement in supplying process of FP services (p=0.308). There was no improvement in both trained staff (p=0.67) and midwifery staff (p=0.75); however, there was a significant improvement in the rest of the structure at the risk of 10% (p=0.063) and the performance in FP (p<0.001). In multivariate analysis, the evolution of the structure was the only explanatory variable (p=0.029) of HFs performance in FP; in rural areas, the structure-process interaction (p=0.038) was the explanatory variable of HFs performance in FP, whereas in suburban and urban areas, the models were not significant. PBF should act not only on the structures but also on the processes of supplying services, taking into account the context.