No impact of performance-based financing on the availability of essential medicines in Burkina Faso: A mixed-methods study.

Autor:	Lohmann J; London School of Hygiene & Tropical Medicine, London, United Kingdom.; Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany., Brenner S; Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany., Koulidiati JL; Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany., Somda SMA; Centre MURAZ, Bobo-Dioulasso, Burkina Faso.; UFR/SEA, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso., Robyn PJ; Health, Nutrition and Population Global Practice, World Bank, Washington, DC, United States of America., De Allegri M; Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Mar 23; Vol. 2 (3), pp. e0000212. Date of Electronic Publication: 2022 Mar 23 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000212
Abstrakt:	Access to safe, effective, and affordable essential medicines (EM) is critical to quality health services and as such has played a key role in innovative health system strengthening approaches such as Performance-based Financing (PBF). Available literature indicates that PBF can improve EM availability, but has not done so consistently in the past. Qualitative explorations of the reasons are yet scarce. We contribute to expanding the literature by estimating the impact of PBF on EM availability and stockout in Burkina Faso and investigating mechanisms of and barriers to change. The study used an explanatory mixed methods design. The quantitative study component followed a quasi-experimental design (difference-in-differences), comparing how EM availability and stockout had changed three years after implementation in 12 PBF and in 12 control districts. Qualitative data was collected from purposely selected policy and implementation stakeholders at all levels of the health system and community, using in-depth interviews and focus group discussions, and explored using deductive coding and thematic analysis. We found no impact of PBF on EM availability and stockouts in the quantitative data. Qualitative narratives converge in that EM supply had increased as a result of PBF, albeit not fully satisfactorily and sustainably so. Reasons include persisting contextual challenges, most importantly a public medicine procurement monopoly; design challenges, specifically a disconnect and disbalance in incentive levels between service provision and service quality indicators; implementation challenges including payment delays, issues around performance verification, and insufficient implementation of activities to strengthen stock management skills; and concurrently implemented policies, most importantly a national user fee exemption for children and pregnant women half way through the impact evaluation period. The case of PBF and EM availability in Burkina Faso illustrates the difficulty of incentivizing and effecting holistic change in EM availability in the presence of strong contextual constraints and powerful concurrent policies. Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: This work was supported by The World Bank through the Health Results Innovation Trust Fund (HRITF). The World Bank was engaged in the overall design of the intervention and the impact evaluation (IE), but had no role in data collection, data management, data analysis and interpretation, preparation, review and approval of the manuscript. MDA was the Principal Investigator of the IE, but received no direct compensation from the World Bank. JL, SB, and JLK were fully or partially funded by the HRITF grant to the University and worked on the IE (data collection, management, and reporting to the World Bank), but received no direct payment by the Bank nor any compensation for manuscript preparation (which occurred outside the framework of the contract with the World Bank). SMAS is an employee of Centre MURAZ, but not directly funded by the HRITF grant allocated to Centre MURAZ for data collection. PJR is a World Bank employee and Co-PI of the impact evaluation, but participated in writing of this paper independently of his professional engagement. The views reported in this paper represent the views of the authors exclusively and not those of the funding agency. (Copyright: © 2022 Lohmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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