Measuring and understanding the effects of a performance based financing scheme applied to nutrition services in Burundi—a mixed method impact evaluation design

Nimpagaritse, Manassé; Korachais, Catherine; Roberfroid, Dominique; Kolsteren, Patrick; Idrissi, Moulay Driss Zine Eddine El; Meessen, Bruno

doi:10.1186/s12939-016-0382-0

Cited by 13 publications

(18 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study builds on an impact evaluation of the Performance Based Financing (PBF) scheme applied to malnutrition in Burundi's health centres. A full presentation of the research has been published elsewhere [16]. The research protocol was approved by ethical committees in Burundi and at the University of Antwerp, as well as the Institutional Review Board of the Institute of Tropical Medicine, Belgium.…”

Section: Methodsmentioning

confidence: 99%

“…Results displayed in Table 6 and Table 7 suggest that HWs with the 'management of severe acute malnutrition' as part of their daily activities were the most likely to ask systematically the question regarding 'ongoing breastfeeding' with a difference of 16 With regards to nutrition examinations, findings suggest that HWs who had received an in-service training since the end of their studies and those with the management of severe acute malnutrition as part of their daily activities were the most likely to systematically perform a weight examination (with a difference of respectively 16 On the other hand, male HWs, those who do not have the management of MAM or SAM as part of their activities and those who had not received any in-service training were most likely to never perform the height/ length examination. Finally, HWs who do not have the management of SAM as part of their activities and those who had not received any in-service training since the end of their studies predominantly never calculated the WHZ-score.…”

Section: Performance Of Health Workers In Relation To Nutrition Advicementioning

confidence: 99%

See 1 more Smart Citation

Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi?

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The Integrated Management of Childhood Illness (IMCI) strategy was adopted in Burundi in 2003. Our aim was to evaluate to what extent the malnutrition component of the IMCI guidelines is implemented at health facilities level. Methods: We carried out direct observations of curative outpatient consultations for children aged 6-59 months in 90 health centres selected randomly. We considered both the child and the health worker (HW) as units of analysis and used bivariate analysis to explore characteristics of HWs associated with tasks systematically or never performed.Results: A total of 514 consultations carried out by 145 HWs were observed. Among the 250 children under two years, less than 30% were asked questions on breastfeeding. None of them had all seven nutrition-related questions asked to their caregivers and none of the 200 children over the age of two years had all five nutrition-related questions asked to their caregivers. Only 13 cases (3%) had all of the six examinations/tasks (weight, height/length, mid-upper arm circumference, oedema, filling in and discussing the growth curve and calculating the weight for height z-score) performed as part of their care. 393 cases (76%) reported that they had not being given any nutrition advice. With regards to HWs, among 99 of them who had received children under two, only 21 (21.2%)[14.2-30.5%) systematically asked the question regarding 'ongoing breastfeeding'. Only 56 (38.6%)[31-46.9%] weighed or discussed the weight taken prior the consultation for each child they reviewed, only 38 (26.2%) [19.6-34.1%] measured the height/length or discussed it for each child reviewed and 23 (15.9%)[10.7-22.8%] performed (systematically?) the WHZ-score. More than 50% never gave nutrition advices to any child reviewed. HWs who daily manage severe acute malnutrition were the most likely to systematically ask the question regarding 'ongoing breastfeeding' and to perform a 'weight examination'. Those who had not received supervision visit on the topic of malnutrition predominantly never performed a 'weight examination'. The 'height/length' examination' was predominantly performed by female HWs and those who have 'contract with the government.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Performance Of Health Workers In Relation To Nutrition Advicementioning

confidence: 99%

Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi?

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…The protocol of this impact evaluation is described elsewhere [22]. Briefly, the study has a cluster-randomized controlled trial design, with health center as the primary unit of sampling and sous-colline (the smallest administrative entity with a variable number of villages) as the secondary unit sampling.…”

Section: Methodsmentioning

confidence: 99%

Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national cross-sectional household survey, 2014

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundBurundi is one of the poorest countries and is among the four countries with the highest prevalence of stunting (58%) among children aged less than 5 years. This situation undermines the economic growth of the country as undernutrition is strongly associated with less schooling and reduced economic productivity. Identifying the determinants of stunting and severe stunting may help policy-makers to direct the limited Burundian resources to the most vulnerable segments of the population, and thus make it more cost effective. This study aimed to identify predictors of stunting and severe stunting among children aged less than two years in Burundi.MethodsThe sample is made up of 6199 children aged 6 to 23 months with complete anthropometric measurements from the baseline survey of an impact evaluation study of the Performance-Based financing (PBF) scheme applied to nutrition services in Burundi from 2015 to 2017. Binary and multivariable logistic regression analyses were used to examine stunting and severe stunting against a set of child, parental and household variables such as child’s age or breastfeeding pattern, mother’s age or knowledge of malnutrition, household size or socio-economic status.ResultsThe prevalence of stunting and severe stunting were 53% [95%CI: 51.8-54.3] and 20.9% [95%CI: 19.9-22.0] respectively. Compared to children from 6-11 months, children of 12-17 months and 18-23 months had a higher risk of stunting (AdjOR:2.1; 95% CI: 1.8-2.4 and 3.2; 95% CI: 2.8-3.7). Other predictors for stunting were small babies (AdjOR=1.5; 95% CI: 1.3-1.7 for medium-size babies at birth and AdjOR=2.9; 95% CI: 2.4-3.6 for small-size babies at birth) and male children (AdjOR=1.5, 95% CI: 1.4-1.8). In addition, having no education for mothers (AdjOR=1.6; 95% CI: 1.2-2.1), incorrect mothers’ child nutrition status assessment (AdjOR=3.3; 95% CI: 2.8-4), delivering at home (AdjOR=1.4; 95% CI: 1.2-1.6) were found to be predictors for stunting. More than to 2 under five children in the household (AdjOR=1.45; 95% CI: 1.1-1.9 for stunting and AdjOR= 1.5; 95% CI: 1.2-1.9 for severe stunting) and wealth were found to be predictors for both stunting and severe stunting. The factors associated with stunting were found to be applicable for severe stunting as well.ConclusionMother’s education level, mother’s knowledge about child nutrition status assessment and health facility delivery were predictors of child stunting. Our study confirms that stunting and severe stunting is in Burundi, as elsewhere, a multi-sectorial problem. Some determinants relate to the general development of Burundi: education of girls, poverty, and food security; will be addressed by a large array of actions. Some others relate to the health sector and its performance – we think in particular of the number of children under five in the household (birth spacing), the relationship with the health center and the knowledge of the mother on malnutrition. Our findings confirm that the Ministry of Health and its partners should strive for better performi...

show abstract

“…The research design was a cluster randomised control trial, whose main aim was to measure the effects of the PBF-N on nutrition outcomes (45 intervention HCs received a payment conditional to their performance on a list of nutrition indicators, 45 control HCs received a financial compensation equivalent to the PBF subsidies received on average by intervention HCs). A full presentation of the intervention and the research design and an introduction to the various research instruments are available in Nimpagaritse et al [35].…”

Section: Methodsmentioning

confidence: 99%

“…the 'supervision track') and were listed so as not to miss something. This theoretical mapping inspired the development of a large set of research instruments to capture the transmission (or non-transmission) of the effects of the PBF scheme at the HC level [35]. We will more extensively present and use these seven tracks to structure our findings in the results section.…”

Section: Methodsmentioning

confidence: 99%

Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi

2020

Self Cite

View full text Add to dashboard Cite

Background From January 2015 to December 2016, the health authorities in Burundi piloted the inclusion of child nutrition services into the pre-existing performance-based financing free health care policy (PBF-FHC). An impact evaluation, focused on health centres, found positive effects both in terms of volume of services and quality of care. To some extent, this result is puzzling given the harshness of the contextual constraints related to the fragile setting. Methods With a multi-methods approach, we explored how contextual and implementation constraints interacted with the pre-identified tracks of effect transmission embodied in the intervention. For our analysis, we used a hypothetical Theory of Change (ToC) that mapped a set of seven tracks through which the intervention might develop positive effects for children suffering from malnutrition. We built our analysis on (1) findings from the facility surveys and (2) extra qualitative data (logbooks, interviews and operational document reviews). Findings Our results suggest that six constraints have weighted upon the intervention: (1) initial low skills of health workers; (2) unavailability of resources (including nutritional dietary inputs and equipment); (3) payment delays; (4) suboptimal information; (5) restrictions on autonomy; and (6) low intensity of supervision. Together, they have affected the intensity of the intervention, especially during its first year. From our analysis of the ToC, we noted that the positive effects largely occurred as a result of the incentive and information tracks. Qualitative data suggests that health centres have circumvented the many constraints by relying on

show abstract

Measuring and understanding the effects of a performance based financing scheme applied to nutrition services in Burundi—a mixed method impact evaluation design

Cited by 13 publications

References 17 publications

Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi?

Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi?

Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national cross-sectional household survey, 2014

Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi

Contact Info

Product

Resources

About