Misunderstandings and ambiguities in strategic purchasing in low‐ and middle‐income countries

Paul, Élisabeth; Brown, Garrett Wallace; Ridde, Valéry

doi:10.1002/hpm.3019

Cited by 16 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 12 At least one study showed that the policy dialogue surrounding the introduction of PBF in sub-Saharan Africa also raised awareness about strategic purchasing more generally, although perhaps in a misleading way that equated PBF with strategic purchasing and kept the policy dialogue narrowly defined. 12 , 62 …”

Section: Resultsmentioning

confidence: 99%

Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence

Waithaka

Cashin

Barasa

2022

Health Systems & Reform

View full text Add to dashboard Cite

Many countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF “works”—that is, whether it leads to improvements in indicators tied to incentive-based payments. Because PBF schemes embody key elements of strategic health purchasing, this study examines the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within country health financing arrangements. We searched PubMed, Scopus, EconLit, Cochrane Database of Systematic Reviews, Google Scholar, Google, and the World Health Organization and World Bank’s repositories for studies that focused on the implementation experience or effects of PBF in sub-Saharan African and published in English from 2000 to 2020. We identified 44 papers and used framework analysis to analyze the data and generate key findings. The evidence we reviewed shows that PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system. We concluded that PBF has not systematically transformed health purchasing in countries in sub-Saharan Africa but that the experience with PBF can provide valuable lessons for how system-wide strategic purchasing can be implemented most effectively in that region—either in countries that currently have PBF schemes and aim to integrate them into broader purchasing systems, or in countries that are not currently implementing PBF. We also concluded that for countries to pursue more holistic approaches to strategic health purchasing and achieve better health outcomes, they need to implement health financing reforms within or aligned with existing financing systems.

show abstract

Section: Resultsmentioning

confidence: 99%

Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence

Waithaka

Cashin

Barasa

2022

Health Systems & Reform

View full text Add to dashboard Cite

show abstract

“…The channels discussed are consistent with an early hypothesis that PBF would improve health worker effort and thus the quality of care provided in primary health care settings . At the same time, these PBF programs have come under criticism on several counts, in particular their complexity of design and implementation, donor-driven backing, and potential to degrade health systems by crowding out intrinsic health worker motivation Paul, Brown, and Ridde 2020). The chapter thus considered impacts on service utilization and quality of care as well as health worker motivation and satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Improving Effective Coverage in Health: Do Financial Incentives Work?

Walque¹,

Kandpal²,

Wagstaff³

et al. 2022

View full text Add to dashboard Cite

Some rights reserved 1 2 3 4 25 24 23 22 This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy, completeness, or currency of the data included in this work and does not assume responsibility for any errors, omissions, or discrepancies in the information, or liability with respect to the use of or failure to use the information, methods, processes, or conclusions set forth. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

show abstract

“…A central criticism of PBF interventions pertains to their complexity of design and implementation and their donor-driven backing [ 22 , 23 , 62 ]. Indeed, a systematic review of interventions designed to improve provider effort finds that simpler interventions work better than multifaceted ones [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

Khanna

Loevinsohn

Pradhan

et al. 2021

BMC Med

View full text Add to dashboard Cite

Background Health system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria. Methods We sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors. Results PBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05). Conclusions Our findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery. Trial registration ClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.

show abstract

Misunderstandings and ambiguities in strategic purchasing in low‐ and middle‐income countries

Cited by 16 publications

References 20 publications

Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence

Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence

Improving Effective Coverage in Health: Do Financial Incentives Work?

Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

Contact Info

Product

Resources

About