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The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire

Low quality of care is a significant problem for health systems in low-income and middle-income countries (LMICs). Policymakers are increasingly interested in using performance-based financing (PBF), a system-wide provider payment reform, conditioned on both quantity and quality of performance, to i...

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Autores principales: Duran, Denizhan, Bauhoff, Sebastian, Berman, Peter, Gaudet, Tania, Konan, Clovis, Ozaltin, Emre, Kruk, Margaret E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528372/
https://www.ncbi.nlm.nih.gov/pubmed/32999053
http://dx.doi.org/10.1136/bmjgh-2020-002934
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author Duran, Denizhan
Bauhoff, Sebastian
Berman, Peter
Gaudet, Tania
Konan, Clovis
Ozaltin, Emre
Kruk, Margaret E
author_facet Duran, Denizhan
Bauhoff, Sebastian
Berman, Peter
Gaudet, Tania
Konan, Clovis
Ozaltin, Emre
Kruk, Margaret E
author_sort Duran, Denizhan
collection PubMed
description Low quality of care is a significant problem for health systems in low-income and middle-income countries (LMICs). Policymakers are increasingly interested in using performance-based financing (PBF), a system-wide provider payment reform, conditioned on both quantity and quality of performance, to improve quality of care. The health system context influences both the design and the implementation of these programmes and thus their effectiveness. This study analyses how context has influenced the design and implementation of PBF in improving the quality of primary care in one particular setting, Cote d’Ivoire, a lower-middle income country with some of the poorest health outcomes in the world. Based on literature, an analytical framework was developed identifying five pathways through which financial incentives can influence the quality of primary care: earmarking, conditioning, provider behaviour, community involvement and management. Guided by this framework, semistructured interviews were conducted with policymakers and providers to diagnose the context and to assess the links between financing and quality of care at the primary care level. PBF in Cote d’Ivoire was found to have increased data availability and quality, facility-wide and disease-specific inputs, provider motivation and management practices in contracted facilities, but had limited success in improving process and outcome measures of quality, as well as community involvement and the provision of non-incentivised services. These limitations were attributable to a centralised health system structure constraining the decision space of health providers; financing and governance challenges across the health sector; and shortcomings with regard to the design of the PBF quality checklist and incentive structures in Cote d’Ivoire. In order to improve the quality of primary care, health sector reforms such as PBF should incorporate the organisational and service delivery context more broadly into their design and implementation, as is the case in other countries.
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spelling pubmed-75283722020-10-19 The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire Duran, Denizhan Bauhoff, Sebastian Berman, Peter Gaudet, Tania Konan, Clovis Ozaltin, Emre Kruk, Margaret E BMJ Glob Health Original Research Low quality of care is a significant problem for health systems in low-income and middle-income countries (LMICs). Policymakers are increasingly interested in using performance-based financing (PBF), a system-wide provider payment reform, conditioned on both quantity and quality of performance, to improve quality of care. The health system context influences both the design and the implementation of these programmes and thus their effectiveness. This study analyses how context has influenced the design and implementation of PBF in improving the quality of primary care in one particular setting, Cote d’Ivoire, a lower-middle income country with some of the poorest health outcomes in the world. Based on literature, an analytical framework was developed identifying five pathways through which financial incentives can influence the quality of primary care: earmarking, conditioning, provider behaviour, community involvement and management. Guided by this framework, semistructured interviews were conducted with policymakers and providers to diagnose the context and to assess the links between financing and quality of care at the primary care level. PBF in Cote d’Ivoire was found to have increased data availability and quality, facility-wide and disease-specific inputs, provider motivation and management practices in contracted facilities, but had limited success in improving process and outcome measures of quality, as well as community involvement and the provision of non-incentivised services. These limitations were attributable to a centralised health system structure constraining the decision space of health providers; financing and governance challenges across the health sector; and shortcomings with regard to the design of the PBF quality checklist and incentive structures in Cote d’Ivoire. In order to improve the quality of primary care, health sector reforms such as PBF should incorporate the organisational and service delivery context more broadly into their design and implementation, as is the case in other countries. BMJ Publishing Group 2020-09-30 /pmc/articles/PMC7528372/ /pubmed/32999053 http://dx.doi.org/10.1136/bmjgh-2020-002934 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Duran, Denizhan
Bauhoff, Sebastian
Berman, Peter
Gaudet, Tania
Konan, Clovis
Ozaltin, Emre
Kruk, Margaret E
The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title_full The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title_fullStr The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title_full_unstemmed The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title_short The role of health system context in the design and implementation of performance-based financing: evidence from Cote d’Ivoire
title_sort role of health system context in the design and implementation of performance-based financing: evidence from cote d’ivoire
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528372/
https://www.ncbi.nlm.nih.gov/pubmed/32999053
http://dx.doi.org/10.1136/bmjgh-2020-002934
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