Performance-based financing contributes to the resilience of health services affected by the Liberian Ebola outbreak

Vg, Mussah; Mapleh, L; Adé, S.; Harries, A. D.; Bhat, Prashant; Kateh, Francis; Dahn, Bernice

doi:10.5588/pha.16.0096

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…The answer to this second question is probably yes: there was indeed an improvement in immunization performance (fully vaccinated children) for the health facilities of the two health zones over the period of study. This finding is also consistent with that made by several authors such as Ndikubagenzi et coll [10] in Burundi, Bonfrer and coll [11], Mussah and coll [12] in Liberia. Indeed, Ndikubagenzi and coll [10] found a statistically significant increase in the average increase in female users of PF services between the pre-scaling and post-scaling period of RBF in that country.…”

Section: Discussionsupporting

confidence: 93%

“…Similarly, Bonfrer et al [11] noted a 4% improvement in the likelihood of a child being fully vaccinated with a more pronounced effect in the poorest. In Liberia, Mussah et al [12] found that, compared to regions not supported by a performance-based funding project, regions supported by such a project experienced less deterioration in key maternal and child health indicators during the Ebola epidemic and a better improvement in these indicators in the post-Ebola period. On the contrary, no significant impact has been found on clinical productivity in Benin [9] and Eldridge and Palmer [13] have not found clear evidence on the effects of any type of RBF in the health context of any low-income country.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Performance Based Financing on Health Facilities Performance in Immunization in Two Health Districts in Benin

Maurice¹,

David²,

Emmanuel³

et al. 2020

CAJPH

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Background: two pilot studies of RBF have been conducted in some health districts of Benin since 2012, which results have been scaled up in 2015. Then, it's important to see whether the impacts of health care from those studies will be confirmed by HFs performance in IS. Objective: to analyze the impact of RBF on IS performance in Parakou/N'dali and Nikki/Kalalé/Pèrèrè health districts, through the quality of the structure and the process of supplying these services, and their possible association with the immunization services performance. Method: A retrospective study was conducted including all public and private functional HFs covered by the period of 14 trimesters (T1 2014 to T2 2017). The dependent variable was the performance in IS. The independent variables were the quality of the structure, the quality of the process and the environment. A linear regression model was adjusted; the significance threshold was 5%. Results: 55 HFs participated to the study; they were mostly in rural areas (76.4%) and 36.4% were at the first level of the pyramid. There was no improvement in both trained staff (p=0.67) and midwifery staff (p=0.75) and in the rest of the structure (p=0.697); however there was a significant improvement in supplying process of immunization services (p=0.001) and the performance in IS (p=0.010). In multivariate analysis, overall and in cluster by area analysis, models were not significant. Conclusion: RBF act only on the processes of supplying immunization services to improve HF performance, taking into account the environment. No explained factors were found for this performance improvement. Local dynamics in each HF should be in action which can be uncover in interactions with local actors.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Impact of Performance Based Financing on Health Facilities Performance in Immunization in Two Health Districts in Benin

Maurice¹,

David²,

Emmanuel³

et al. 2020

CAJPH

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“…In Pujehun, the implementation of an RS immediately after the acute Ebola phase might have reduced delays in patients accessing care and enabled a significant improvement in all MCH indicators at hospital level. Other studies have also found that using this window of opportunity to introduce systems such as performance-based financing can also produce positive outcomes 49. As Sierra Leone continues its recovery, there is a need to quantify the impact of the outbreak on MCH care to guide long-term strategies for MHC services.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study

et al. 2019

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ObjectivesTo assess the trends concerning utilisation of maternal and child health (MCH) services before, during and after the Ebola outbreak, quantifying the contribution of a reorganised referral system (RS).DesignA prospective observational study of MCH services.SettingPujehun district in Sierra Leone, 77 community health facilities and 1 hospital from 2012 to 2017.Main outcome measuresMCH utililization was evaluated by assessing: (1) institutional deliveries, Cesarean-sections, paediatric and maternity admissions and deaths, and major direct obstetric complications (MDOCs), at hospital level; (2) antenatal care (ANC) 1 and 4, institutional delivery and family planning, at community level. Contribution of a strengthened RS was also measured.ResultsAt hospital level, there is a significant difference between trends Ebola versus pre-Ebola for maternal admissions (7, 95% CI 4 to 11, p<0.001), MDOCs (4, 95% CI 1 to 7, p=0.006) and institutional deliveries (4, 95% CI 2 to 6, p=0.001). There is also a negative trend in the transition from Ebola to post-Ebola for maternal admissions (−7, 95% CI −10 to −4, p<0.001), MDOCs (−4, 95% CI −7 to −1, p=0.009) and institutional deliveries (−3, 95% CI −5 to −1, p=0.001). The differences between trends pre-Ebola versus post-Ebola are only significant for paediatric admissions (3, 95% CI 0 to 5, p=0.035). At community level, the difference between trends Ebola versus pre-Ebola and Ebola versus post-Ebola are not significant for any indicators. The differences between trends pre-Ebola versus post-Ebola show a negative difference for institutional deliveries (−7, 95% CI −10 to −4, p<0.001), ANC 1 (−6, 95% CI −10 to −3, p<0.001), ANC 4 (−8, 95% CI −11 to −5, p<0.001) and family planning (−85, 95% CI −119 to −51, p<0.001).ConclusionsA stronger health system compared with other districts in Sierra Leone and a strengthened RS enabled health facilities in Pujehun to maintain service provision and uptake during and after the Ebola epidemic.

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“…6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes.…”

mentioning

confidence: 99%

“…One Liberian study showed that primary health care indicators recovered more quickly post-Ebola in a county that benefited from performance-based financing. 22 Nevertheless, improved and sustained coverage of the population's health care needs will only be possible when the dramatic workforce gap is addressed, as shown by a Sierra Leone study. 15 The operational research performed demonstrates the importance of studying the effect of the EVD outbreak on health system performance, and how adaptive approaches may improve the utilisation and provision of health services.…”

mentioning

confidence: 99%

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

Decroo

Fitzpatrick

Amone

2017

public health action

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The West African Ebola virus disease (EVD) outbreak was the largest in history. The vast majority of cases were reported in Guinea, Sierra Leone and Liberia. Altogether, 28 646 people were infected and 11 323 died. 1 One of the explanations for the extent of the outbreak was the lack of response of local health systems. These health systems were incapable of responding adequately to the outbreak due to a lack of human resources, information, research, supply of medical products, financing and governance. 2 The devastating effect of the Ebola outbreak stretched far beyond the number of Ebola cases, and resulted in the deterioration of the provision and utilisation of routine health care. On the one hand the EVD outbreak compromised the functioning of the health system, due to the deaths of many health care workers and the closure of health facilities, 3,4 while at the same time communities had little trust in the capacity of providers to secure safe health care. In Ebola-affected communities many individuals feared to seek care, even for curable conditions. 4,5 The manner in which the provision and utilisation of programmes were affected by the outbreak was difficult to monitor during the outbreak response, given the state of emergency. All the attention of national and international health care providers was focused on limiting further spread of EVD, and reducing mortality in infected patients. We therefore studied in retrospect the effect of the Ebola outbreak on health system performance. Two Structured Operational Research Training Initiative (SORT IT) courses were organised, one in Liberia and one in Sierra Leone. The participants, the first authors of the manuscripts included in this supplement, were involved in the local health programmes during the Ebola outbreak. Course participation was defined as successful if the participant submitted a scientific manuscript to a peer-reviewed journal by the end of the course. 6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes. In addition, infection prevention monitoring, community health worker programme and performance-based financing are included.The different studies illustrate how service delivery and utilisation of most programmes dropped significantly during the Ebola outbreak. The greater the area affected, the sharper the decline, and the longer it took for performance to recover to pre-Ebola levels. The level of programme performance pre-Ebola also affected recovery post-Ebola. For example, in Liberia the already struggling immunisation programme was further weakened during the outbreak and took significant time to recover post-Ebola. 19 Ne...

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Performance-based financing contributes to the resilience of health services affected by the Liberian Ebola outbreak

Cited by 7 publications

References 18 publications

Impact of Performance Based Financing on Health Facilities Performance in Immunization in Two Health Districts in Benin

Impact of Performance Based Financing on Health Facilities Performance in Immunization in Two Health Districts in Benin

Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

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