Effects of Results Based Financing on Performance of the Incentivized Indicators. A Quasi-Experimental Study Design.

Abstract

BackgroundDespite the nationwide roll-out of RBF, the National performance of several key incentivized indicators showed a decline in performance in the year 2019/2020 compared to the previous year. MethodThe study took on a quasi-experimental study design. Data from HFs that were part of phase one of the RBF rollout (exposed group) was analyzed and compared to data from HFs in phase three of RBF implementation (Nonexposed group) a time before the rollout of RBF phase three in Uganda. All data analysis was done in Stata using version 16. Results:The study results show that in the exposed group of health facilities, Incentivised indicators changed significantly after the project implementation as regards the average number (mean) of clients served by the health facilities; p< 0.01, p<0.05, or p<0.1 for the difference coefficients Similar, though relatively slower effects were observable in the same indicators for an unexposed group of health facilities. IPT2 coverage declined by 6%, health facility deliveries were 59% achieved (89% national target) and declined by 3%, and under-five Vitamin A coverage declined by 9% to 21.4% far below the target of 66%. Essential drug stock declined by 7%, to 46% below the national target of 75% maternal deaths increased by 7.6%, reporting timeliness declined by 12.5% from 97.5% public health facility staffing declined by 3% to 73% against the targeted 80%. Conclusion RBF contributes to improved health service utilization as evidenced by the improved performance of incentivized indicators and improved data quality over time. RecommendationThere is a need to continuously review which indicators are incentivized to achieve quality of care in all health services if it is to be mainstreamed.