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Household costs and time to seek care for pregnancy related complications: The role of results-based financing

Results-based financing (RBF) schemes–including performance based financing (PBF) and conditional cash transfers (CCT)-are increasingly being used to encourage use and improve quality of institutional health care for pregnant women in order to reduce maternal and neonatal mortality in low-income cou...

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Autores principales: Chinkhumba, Jobiba, De Allegri, Manuela, Mazalale, Jacob, Brenner, Stephan, Mathanga, Don, Muula, Adamson S., Robberstad, Bjarne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608189/
https://www.ncbi.nlm.nih.gov/pubmed/28934320
http://dx.doi.org/10.1371/journal.pone.0182326
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author Chinkhumba, Jobiba
De Allegri, Manuela
Mazalale, Jacob
Brenner, Stephan
Mathanga, Don
Muula, Adamson S.
Robberstad, Bjarne
author_facet Chinkhumba, Jobiba
De Allegri, Manuela
Mazalale, Jacob
Brenner, Stephan
Mathanga, Don
Muula, Adamson S.
Robberstad, Bjarne
author_sort Chinkhumba, Jobiba
collection PubMed
description Results-based financing (RBF) schemes–including performance based financing (PBF) and conditional cash transfers (CCT)-are increasingly being used to encourage use and improve quality of institutional health care for pregnant women in order to reduce maternal and neonatal mortality in low-income countries. While there is emerging evidence that RBF can increase service use and quality, little is known on the impact of RBF on costs and time to seek care for obstetric complications, although the two represent important dimensions of access. We conducted this study to fill the existing gap in knowledge by investigating the impact of RBF (PBF+CCT) on household costs and time to seek care for obstetric complications in four districts in Malawi. The analysis included data on 2,219 women with obstetric complications from three waves of a population-based survey conducted at baseline in 2013 and repeated in 2014(midline) and 2015(endline). Using a before and after approach with controls, we applied generalized linear models to study the association between RBF and household costs and time to seek care. Results indicated that receipt of RBF was associated with a significant reduction in the expected mean time to seek care for women experiencing an obstetric complication. Relative to non-RBF, time to seek care in RBF areas decreased by 27.3% (95%CI: 28.4–25.9) at midline and 34.2% (95%CI: 37.8–30.4) at endline. No substantial change in household costs was observed. We conclude that the reduced time to seek care is a manifestation of RBF induced quality improvements, prompting faster decisions on care seeking at household level. Our results suggest RBF may contribute to timely emergency care seeking and thus ultimately reduce maternal and neonatal mortality in beneficiary populations.
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spelling pubmed-56081892017-10-09 Household costs and time to seek care for pregnancy related complications: The role of results-based financing Chinkhumba, Jobiba De Allegri, Manuela Mazalale, Jacob Brenner, Stephan Mathanga, Don Muula, Adamson S. Robberstad, Bjarne PLoS One Research Article Results-based financing (RBF) schemes–including performance based financing (PBF) and conditional cash transfers (CCT)-are increasingly being used to encourage use and improve quality of institutional health care for pregnant women in order to reduce maternal and neonatal mortality in low-income countries. While there is emerging evidence that RBF can increase service use and quality, little is known on the impact of RBF on costs and time to seek care for obstetric complications, although the two represent important dimensions of access. We conducted this study to fill the existing gap in knowledge by investigating the impact of RBF (PBF+CCT) on household costs and time to seek care for obstetric complications in four districts in Malawi. The analysis included data on 2,219 women with obstetric complications from three waves of a population-based survey conducted at baseline in 2013 and repeated in 2014(midline) and 2015(endline). Using a before and after approach with controls, we applied generalized linear models to study the association between RBF and household costs and time to seek care. Results indicated that receipt of RBF was associated with a significant reduction in the expected mean time to seek care for women experiencing an obstetric complication. Relative to non-RBF, time to seek care in RBF areas decreased by 27.3% (95%CI: 28.4–25.9) at midline and 34.2% (95%CI: 37.8–30.4) at endline. No substantial change in household costs was observed. We conclude that the reduced time to seek care is a manifestation of RBF induced quality improvements, prompting faster decisions on care seeking at household level. Our results suggest RBF may contribute to timely emergency care seeking and thus ultimately reduce maternal and neonatal mortality in beneficiary populations. Public Library of Science 2017-09-21 /pmc/articles/PMC5608189/ /pubmed/28934320 http://dx.doi.org/10.1371/journal.pone.0182326 Text en © 2017 Chinkhumba et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Chinkhumba, Jobiba
De Allegri, Manuela
Mazalale, Jacob
Brenner, Stephan
Mathanga, Don
Muula, Adamson S.
Robberstad, Bjarne
Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title_full Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title_fullStr Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title_full_unstemmed Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title_short Household costs and time to seek care for pregnancy related complications: The role of results-based financing
title_sort household costs and time to seek care for pregnancy related complications: the role of results-based financing
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608189/
https://www.ncbi.nlm.nih.gov/pubmed/28934320
http://dx.doi.org/10.1371/journal.pone.0182326
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