Efficiency of HIV/AIDS Health Centers and Effect of Community-Based Health Insurance and Performance-Based Financing on HIV/AIDS Service Delivery in Rwanda

Zeng, Wu; Rwiyereka, Angelique K.; Amico, Peter; Ávila-Figueroa, Carlos; Shepard, Donald S.

doi:10.4269/ajtmh.12-0697

Cited by 21 publications

(26 citation statements)

References 26 publications

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“…In a 2012 evaluation of Rwanda mutuelles by Lu and colleagues, the use of curative care consultations among ill children with mutuelles insurance was double the rate among those without insurance [ 20 ]. This reinforces similar findings of increased service use among the insured in Rwanda [ 21 – 23 ]. Interactions between insurance and PBF and insurance and wealth quintiles were tested but not included due to insignificance.…”

Section: Discussionsupporting

confidence: 90%

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The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda

Skiles

Curtis

Basinga

et al. 2015

BMC Health Serv Res

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BackgroundPerformance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda’s PBF program on less-incentivized child health services and examined the differential program impact by household poverty.MethodsDistricts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007–08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families.ResultsThere was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever.ConclusionsPBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1033-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

“…Interactions between insurance and PBF and insurance and wealth quintiles were tested but not included due to insignificance. Disentangling the effects of PBF from the rise of mutuelles is a difficult but promising area for future study [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda

Skiles

Curtis

Basinga

et al. 2015

BMC Health Serv Res

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“…Abstracts and, where necessary, full text of 352 articles was examined by both reviewers. Of these, 157 were included in the final analysis [ 15 – 171 ]. Eighty-eight percent of included interventions took place across sub-Saharan Africa (Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review

et al. 2017

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BackgroundThe global response to HIV has started over 18 million persons on life-saving antiretroviral therapy (ART)—the vast majority in low- and middle-income countries (LMIC)—yet substantial gaps remain: up to 40% of persons living with HIV (PLHIV) know their status, while another 30% of those who enter care are inadequately retained after starting treatment. Identifying strategies to enhance use of treatment is urgently needed, but the conceptualization and specification of implementation interventions is not always complete. We sought to assess the completeness of intervention reporting in research to advance uptake of treatment for HIV globally.MethodsWe carried out a systematic review to identify interventions targeting the adult HIV care cascade in LMIC dating from 1990 to 2017. We identified components of each intervention as “intervention types” to decompose interventions into common components. We grouped “intervention types” into a smaller number of more general “implementation approaches” to aid summarization.We assessed the reporting of six intervention characteristics adapted from the implementation science literature: the actor, action, action dose, action temporality, action target, and behavioral target in each study.FindingsIn 157 unique studies, we identified 34 intervention “types,” which were empirically grouped into six generally understandable “approaches.” Overall, 42% of interventions defined the actor, 64% reported the action, 41% specified the intervention “dose,” 43% reported action temporality, 61% defined the action target, and 69% reported a target behavior. Average completeness of reporting varied across approaches from a low of 50% to a high of 72%. Dimensions that involved conceptualization of the practices themselves (e.g., actor, dose, temporality) were in general less well specified than consequences (e.g., action target and behavioral target).ImplicationsThe conceptualization and Reporting of implementation interventions to advance treatment for HIV in LMIC is not always complete. Dissemination of standards for reporting intervention characteristics can potentially promote transparency, reproducibility, and scientific accumulation in the area of implementation science to address HIV in low- and middle-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0630-8) contains supplementary material, which is available to authorized users.

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“…During this systematic review several PBF evaluations were identified that were excluded because events without a denominator were reported. For example, rather than reporting coverage, the number of units of service administered in PBF facilities compared to non-PBF facilities were reported in some studies [54, 55]. Since the number of people eligible for these services may be higher in PBF facilities versus non-PBF facilities, or vice versa, it is difficult to draw any conclusion from these data.…”

Section: Discussionmentioning

confidence: 99%

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

Suthar

Nsanzimana

Bärnighausen

et al. 2017

BMC Health Serv Res

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BackgroundAlthough domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.MethodsPubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.ResultsFour studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.ConclusionsAlthough the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1962-9) contains supplementary material, which is available to authorized users.

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Efficiency of HIV/AIDS Health Centers and Effect of Community-Based Health Insurance and Performance-Based Financing on HIV/AIDS Service Delivery in Rwanda

Cited by 21 publications

References 26 publications

The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda

The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda

Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

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