Impact of Performance-Based Financing (PBF) Program on Utilization and Completeness of Partographs in Jimma

Abstract

One of the most important quality thematic areas incentivized in PBF is maternity services which among other aspects include the use and completion of partographs when monitoring women in labor. Use f partographs during labor is a key intervention but it is not widely used due to various factors. Thus, the PBF program in Jimma sought to strengthen its use and completion since Q4 2019. A quasi-experimental design was used to review 7,260 mothers’ records from 2018, 2019 and 2021 from both Buno-Bedele (control) and Jimma (intervention) zones. Impact of the PBF program on partograph utilization and completeness was estimated using difference-in-differences (DiD) models in STATA 15. In 2019, partograph utilization was estimated to be 29.2% (CI: 26.6% - 31.8%) in Jimma and 23.5% (CI: 21.1% - 25.9%) in Buno-Bedele. In 2021, utilization increased to 87.2% (CI: 85.3% - 89.2%) in Jimma and 41.4% (CI: 38.7% - 44.2%) in Buno-Bedele. Out of the labor cases monitored with partographs, the completeness was 60.2% (CI: 58.1% - 62.4%) in Jimma and 51.6% (CI: 49.5% - 53.6%) in Buno-Bedele in 2019. In 2021, the completeness increased to 83.2% (CI: 82.3% - 84.2%) in Jimma and but remained the same in Buno-Bedele, 51.3% (CI: 49.7% - 52.8%). PBF accelerated the rate of improvement for both utilization (DiD: 30.8%, p-value < 0.001) and completion (DiD: 24.9%, p-value < 0.001) of partographs. Incentivizing facilities to improve quality of care coupled with coaching and mentorship of health workers is effective in improving quality of service for pregnant women in labor and delivery.

Factors Associated with partographs Utilization in Jimma and Bedele Zones, Oromia Regional State, Ethiopia

“…The proportion of partograph utilization among Midwife of Jimma zone was 16.1% for diploma and 15.3% for BSc Midwife which were too low comparing to the research conducted in Jigjiga Somalia region which was 66.7% of Midwives were utilizing partograph [60]. But this result is high compared to Bedele zone which were 10.7% and 11.6% for diploma and BSc midwife respectively [60].…”

“…But this result is high compared to Bedele zone which were 10.7% and 11.6% for diploma and BSc midwife respectively [60]. The reason for this might be due to rigorous coaching and mentoring by verification officer during verification [60]. The utilization of partograph in a study by Dube 2022, was 18.2% higher than the study conducted in Addis Ababa 5 years ago which was 69% [27].…”

“…The utilization of partograph in a study by Dube 2022, was 18.2% higher than the study conducted in Addis Ababa 5 years ago which was 69% [27]. It can be said that the PBF project have a positive effect on partograph utilization which is evidenced by during the verification of quantity and quality assessment couching and mentorship was provided intensively for obstetric care giver [60].…”

“…A recent study revealed that PBF program in Jimma zone strengthened the utilization and completion of partographs among obstetric care provider found in Jimma zone through coaching and mentorship of health workers by PBF verifiers and Woreda Health experts since Q4 2019 [60]. This study findings for Jimma partograph utilization indicate 87.2% and 41.4% for Buno-Bedele and the difference can be attributed to obstetric care providers who have been incentivized through performance-based financing and given mentorship and coaching in Jimma [60]. Our study findings are in-line with these findings as routine use of partographs is confirmed in Jimma (61.9%) compared to Buno-Bedele (32.2%).…”

“…Jimma zone was the intervention site while Buno-Bedelle zone was the control site. Since the launching of the PBF program in Jimma Zone in October 2019 (phase 1), it has been implemented in 13 Woredas [60]. From January 2021 (phase 2), the program was scaled up to the remaining 8 woredas of the zone, involving a total of 7 DH (District Hospitals), and 121 HCs (Health Centers), with estimated 3.7 million inhabitants [60].…”