Background: Since 2011, Benin adhered to results-based financing (RBF), with the implementation of RBF_PRPSS model by Health System Performance Strengthening Project (PRPSS) and RBF_PASS model by health system support project (PASS). Notwithstanding the lack of evidence on this experimental phase, the Ministry of Health initiated the extension of the RBF_PRPSS model to uncovered areas. This comparative study was led to evaluate the health system performance in RBF zones.
Methods: The study examined data from sixty-seven health facilities in six health zones offering maternal and child health services, using the double difference, the Student's test and the variance comparison, with 5% significance level.
Results: The study found that between 2011 and 2014, staff numbers remained stable in the RBF strata (p>0.05). The cumulative duration over a six-month period of stock-outs of five key drugs (paracetamol, amoxicillin, oxytocin, iron, sulfadoxine pyrimetamine) decreased from 51 days to 29 days (p<0.05). Direct revenues per health facility increased more in the RBF strata (p<0.05). Financial viability increased in RBF_PRPSS stratum. Health services utilization improved significantly for institutional delivery, tetanus toxoid immunization, DTP (Hib) HepB 3 and MCV immunization and curative care. Decreasing of maternal and neonatal mortalities in RBF strata were not significant.
Conclusions: In sum, the RBF implementation has not yet generated a significant effect on the overall performance of the health system in exposed areas, although it is already accompanied by a significant improvement in the utilization of certain health care services.
Le Projet AIDSTAR-Two. Le manuel FBP: Conception et mise en place de programmes efficaces de financement basé sur la performance. Version 1.0 Cambridge: Management Sciences for Health ; 2011.
Fritsche GB, Soeters R, Meessen B. Performance-Based Financing Toolkit. Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0; 2014.
Soeters R, Habineza C, Peerenboom P. Performance-based financing and changing the district health system:experience from Rwanda. Bull World Health Organ. 2006;84:884-9.
Basinga P, Gertler P, Binagwaho A, Soucat A, Sturdy J, Vermeersch C. Paying primary health centres for performance in Rwanda. World Bank, Washington, DC, Policy research working paper 5190. 2010.
Peabody JW, Florentino J, Shimkhada R, Solon O, Quimbo S. Quality variation and its impact on costs and satisfaction:evidence from the QIDS study. Medical Care. 2010;48:25–30.
Institut National de la Statistique et de l’Analyse Économique (INSAE) et ICF International. Enquête Démographique et de Santé du Bénin 2011-2012. Calverton, Maryland, USA :INSAE et ICF International; 2013.
PRPSS "Projet de Renforcement de la Performance du Système de Santé". Document de cadrage du financement basé sur les résultats (FBR) au Bénin, version validée. Janvier 2014.
PARZS "Projet d’Appui Renforcement des Zones Sanitaires". Document d’orientation intégration du FBR dans le PARZS. Version septembre; 2012.
République Bénin, Institut National de la Statistique et de l’Analyse Économique. RGPH4 :que retenir des effectifs de population en 2013? Cotonou, 2015.
Gertler PJ, Martinez S, Premand P, Rawlings LB, Vermeersch CMJ. L’évaluation d’impact en pratique. World Bank; 2011.
Zang O, Djienouassi S, Sorgho G, Taptue JC. Impact of performance based financing on health-care quality and utilization in urban areas of Cameroon. African Health Monitor. 2015;20:10-5.
Soeters R, Peerenboom BP, Mushagalusa P, Kimanuka C. Performance-based financing experiment improved health care in the Democratic Republic of Congo. Health Affairs. 2011;30(8):1518-27.
Ireland M, Paul E, Dujardin B. Can performance-based financing be used to reform health systems in developing countries? Bull World Health Organ. 2011;89(9):695-8.
Organisation Mondiale de la Santé. Rapport sur la santé dans le monde; travailler ensemble pour la santé. Genève: OMS; 2006.
République du Bénin. Plan stratégique de développement des ressources humaines du secteur Santé 2009-2018. Cotonou; 2008.
Kalk A, Paul FA, Grabosch E. ‘Paying for performance’ in Rwanda:does it pay off? Trop Med Int Health. 2010;15(2):182-90.
Keugoung B, Tsafack JP, Fouelifack FY, Sieleunou I, Noubosse IA, Boulenger D. Expérience pilote de financement basé sur la performance dans le Diocèse de Batouri au Cameroun:leçons pour l’extension du modèle. PBF CoP Working Paper, WP 2; 2011.
Liu X, Mills A. The influence of bonus payments to doctors on hospital revenue:results of a quasi-experimental study. Applied Health Economics & Health Policy. 2003;2:91-8.
Soeters R, Kiwanuka C. Rapport de l’Etude d’Evaluation du programme Achat de Performance dans les Provinces Bubanza et Cankuzo, basé sur les résultats des enquêtes ménages, qualité́ et infirmiers titulaires ré́alisées en 2006 et 2008. Report for Cordaid 2009.
Binyaruka P, Patouillard E, Powell­Jackson T, Greco G, Maestad O, Borghi J. Effect of Paying for Performance on Utilization, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study. PLoS ONE. 2015;10(8):e0135013.
Bonfrer I, Soeters R, van de Poel E, Basenya O, Longin G, van de Looij F, et al. The eﬀects of performance-based financing on the use and quality of health care in Burundi:an impact evaluation. The Lancet. 2013;381:S19.
Huillery E, Seban J. Performance Based Financing for Health: Experimental Evidence from the Democratic Republic of Congo. ENS France Working paper; 2013.
Soeters R, Kimakuka C. Résultats de l’enquête ménage, l’enquête qualité́, et l’enquête infirmiers titulaires. Pour le Programme Achat de Performance dans les Zones de Santé du District Sanitaire Nord du Sud Kivu. 2008.
Canavan A, Swai G. Payment for Performance (P4P) Evaluation: Tanzania Country Report for Cordaid Godfrey Swai, National Consultant Width 1. KIT, Amsterdam; 2008.
Vergeer P, Chansa C. Payment for Performance (P4P) Evaluation: Zambia Country Report for Cordaid. KIT, Amsterdam, 2008.
Lagarde M, Burn S, Lawin L, Bello K, Dossou J-P, Makoutode P, et al. Exploring the impact of Performance-Based Financing on Health Workers’ Performance in Benin. September 2015. Available at: http://www.rbfhealth.org/sites/rbf/files/Benin% 20RBFHRH%20report.pdf. Accessed 5 June 2018.
Mayaka MS. Le financement base sur la performance dans un système de santé complexe:cas de la République Démocratique du Congo [Thèse doctorat]. Santé Publique: Bruxelles; 2015: 309 pages Available at: http://hdl.handle.net/ 2078.1/165401. Accessed on 12 November 2015.
Kalk A. the costs of performance-based financing. Bull World Health Organ. 2011;89(5):319-9.
République du Burundi. Rapport de mise en œuvre du financement basé sur la performance et la gratuité des soins pour l’année 2014. Cellule Technique Nationale FBP; 2015.
Bosch-Capblanch X, Ronveaux O, Doyle V, Remedios V, Bchir A. Accuracy and quality of immunization information systems in forty-one low income countries. Trop Med Int Health. 2009;14(1):2-10.