Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial

Dale, Elina; Agarwal, Ankush; Agarwal, Arunika; Alonge, Olakunle; Edward, Anbrasi; Gupta, Shivam; Schuh, Holly B.; Burnham, Gilbert; Peters, David H.

doi:10.1093/ije/dyv362

Cited by 76 publications

(139 citation statements)

References 16 publications

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“…There was also no effect observed on the routine review of patients’ HIV status. Mixed effect patterns regarding clinical assessment practices in maternal and child services, both history- and exam-based, were also observed in performance-based financing schemes in Afghanistan and Egypt 19 , 44 . Although less obvious, these findings may nevertheless point towards the potential the schemes bring to improve providers’ adherence to routine care standards and clinical guidelines.…”

Section: Discussionmentioning

confidence: 96%

“…This may reflect a complementary effect regarding infection prevention processes between clinical performance and traced supply incentives, which included sterile delivery packs and functional sterilizers, but not gloves, topical antiseptic solutions or other consumables relevant to infection prevention. The role of complementary use of incentives may also explain findings in a study from Afghanistan, 19 which failed to detect significant effects on universal precautions in the absence of relevant equipment and supply improvements.…”

Section: Discussionmentioning

confidence: 99%

“…Recent performance-based financing evaluations in Afghanistan 19 and Burundi 20 failed to detect strong effects of their schemes on health facilities’ ability to secure essential drugs and supplies. A Tanzanian scheme directly providing incentives for facilities to manage essential drugs and supplies failed to prevent stock-outs of essential equipment, medicines and commodities 21 .…”

Section: Introductionmentioning

confidence: 99%

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Implementation research to improve quality of maternal and newborn health care, Malawi

Brenner

Wilhelm

Lohmann

et al. 2017

Bull. World Health Organ.

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ObjectiveTo evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi.MethodsWe conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities’ essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment.FindingsWe observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants’ adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively.ConclusionDespite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation research to improve quality of maternal and newborn health care, Malawi

Brenner

Wilhelm

Lohmann

et al. 2017

Bull. World Health Organ.

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“…In addition, 3 eligible studies were identified from snowballing and grey literature. Of the 13 studies, nine were published in peer‐reviewed journals …”

Section: Resultsmentioning

confidence: 99%

Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review

Blacklock

MacPepple

Kunutsor

et al. 2016

Studies in Family Planning

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Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted.

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“…11,[28][29][30] Criticism has been harsh but still within that narrow project approach. Over the past few years, a large number of P4P initiatives in LMICs have been designed and implemented as separate projects or programs, frequently without due consideration to the rest of the health system and, more specifically, of how these link to existing provider payment mechanisms and broader public finance reforms.…”

Section: Concerns Around the Current P4p Debatementioning

confidence: 99%

Pay-for-Performance Debate: Not Seeing the Forest for the Trees

Soucat

Dale

Mathauer

et al. 2017

Health Systems & Reform

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Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial

Abstract: The intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.

Cited by 76 publications

References 16 publications

Implementation research to improve quality of maternal and newborn health care, Malawi

Implementation research to improve quality of maternal and newborn health care, Malawi

Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review

Pay-for-Performance Debate: Not Seeing the Forest for the Trees

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