TY - JOUR
T1 - An investigation of the relationship between the performance and management practices of health facilities under a performance-based financing scheme in Nigeria
AU - Mabuchi, Shunsuke
AU - Alonge, Olakunle
AU - Tsugawa, Yusuke
AU - Bennett, Sara
N1 - Funding Information:
The research has been funded by the Health Results Innovation Trust Fund (HRITF) at the World Bank and Gavi, the Vaccine Alliance.
Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Whereas the effect of performance-based financing (PBF) on improving the quantity and quality of health services has been established, little is known about what matters for health facilities to improve performance under a PBF scheme. This study examined the associations between management practices and the performance of primary healthcare centres (PHCCs) under a PBF scheme in Nigeria. This study utilized longitudinal data on monthly institutional deliveries and outpatient visits collected between December 2011 and March 2016 from 111 randomly selected PHCCs in Adamawa, Ondo and Nasarawa states of Nigeria. A management practices scorecard, based on a health facility survey conducted in April/May 2016, was used to derive management practices scores for the 111 PHCCs. The management practices examined included activities to recruit and retain clients, staff's attention to performance targets, listening and responding to client feedback, teamwork building and addressing low-performing staff. A multilevel, multilinear regression model was used to investigate the associations between health facility performance (monthly number of institutional deliveries and outpatient visits) and management practices at the PHCCs, adjusting for key control variables (number of skilled health workers, the size of PHCC catchment population, PHCC quality score, seasonality and states). Following PBF introduction, PHCCs with medium management scores had 0.42 (95% CI 0.18-0.65; P < 0.001) and 9.93 (95% CI 6.15-13.71; P < 0.001) higher monthly improvement rates for institutional delivery and outpatient visits, respectively, compared to the PHCCs with low management scores. Also, the PHCCs with high management scores had 0.49 (95% CI 0.28-0.70; P < 0.001) and 5.10 (95% CI 1.76-8.44; P < 0.003) higher monthly improvement rates for institutional delivery and outpatient visits compared to the PHCCs with low management scores. These findings suggest the importance of management practices in facilitating the effect of PBF on health facility performance and the need to strengthen PHCC management practices in low-and middle-income countries.
AB - Whereas the effect of performance-based financing (PBF) on improving the quantity and quality of health services has been established, little is known about what matters for health facilities to improve performance under a PBF scheme. This study examined the associations between management practices and the performance of primary healthcare centres (PHCCs) under a PBF scheme in Nigeria. This study utilized longitudinal data on monthly institutional deliveries and outpatient visits collected between December 2011 and March 2016 from 111 randomly selected PHCCs in Adamawa, Ondo and Nasarawa states of Nigeria. A management practices scorecard, based on a health facility survey conducted in April/May 2016, was used to derive management practices scores for the 111 PHCCs. The management practices examined included activities to recruit and retain clients, staff's attention to performance targets, listening and responding to client feedback, teamwork building and addressing low-performing staff. A multilevel, multilinear regression model was used to investigate the associations between health facility performance (monthly number of institutional deliveries and outpatient visits) and management practices at the PHCCs, adjusting for key control variables (number of skilled health workers, the size of PHCC catchment population, PHCC quality score, seasonality and states). Following PBF introduction, PHCCs with medium management scores had 0.42 (95% CI 0.18-0.65; P < 0.001) and 9.93 (95% CI 6.15-13.71; P < 0.001) higher monthly improvement rates for institutional delivery and outpatient visits, respectively, compared to the PHCCs with low management scores. Also, the PHCCs with high management scores had 0.49 (95% CI 0.28-0.70; P < 0.001) and 5.10 (95% CI 1.76-8.44; P < 0.003) higher monthly improvement rates for institutional delivery and outpatient visits compared to the PHCCs with low management scores. These findings suggest the importance of management practices in facilitating the effect of PBF on health facility performance and the need to strengthen PHCC management practices in low-and middle-income countries.
KW - Health facilities
KW - health system
KW - international health
KW - low-and middle-income countries
KW - management
KW - maternal and child health
KW - performance-based financing
KW - primary healthcare
KW - scorecard
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U2 - 10.1093/heapol/czac040
DO - 10.1093/heapol/czac040
M3 - Article
C2 - 35579285
AN - SCOPUS:85135597730
SN - 0268-1080
VL - 37
SP - 836
EP - 848
JO - Health policy and planning
JF - Health policy and planning
IS - 7
ER -