Title

Effects of result-based funding mechanisms on maternal and child health: a systematic literature review

Date of Award

2008

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Background Recently there have been experiments both in developed and the developing countries with the various forms of results based funding mechanisms with the aim of improvement of health systems performance by linking payments with better health outcomes. This idea to incentivise the healthcare can be targeted at supply or the demand side to introduce changes that are related to the processes related to the delivery of healthcare or providing incentives to the client population for utilizing the health services respectively. Supply side financing interventions can be in the form of payments for performance to individual providers, institutions to improve healthcare performance for example; NGOs and/or health care providers get paid periodically if a set pre-defined performance target is achieved and similarly demand side intervention can be in the form of either cash transfers to patients/clients that are linked with some condition such as attending antenatal health clinics or immunization of children or vouchers for utilizing health care. Given the various issues and challenges, such as the paucity of resources and poor governance, faced by the health systems throughout the developing world and the commitment of the governments of these countries to international commitments such as the MDGs, which includes the reduction in the infant and maternal mortality rates, it becomes mandatory to experiment with various forms of result based funding mechanisms. Though some of these mechanisms have been evaluated yet there is a need to explore their overall impact and determine whether these mechanisms can result in and can be tied to long term health impacts. Objectives The aim of this study is to review the effects of result based funding mechanisms on maternal and child healthcare. Methodology A comprehensive literature search was conducted in a systematic way based on the Cochrane style methodology. The review was divided in 5 stages: stage 1; setting selection criteria for studies and conducting the literature search, stage 2: reviews of the abstracts, stage 3 comprised of reviewing the complete documents, stage 4: quality assessment of the selected documents and finally stage 5: extraction of data from the selected papers and analyses. This review included both peer reviewed published and non-published reports of international agencies and government documents. A wide array of sources was searched including computerized and a manual search using a predefined criteria. Results Out of 946 references retrieved 70 documents were selected for the final review. The overall findings of the review revealed that various result based funding mechanisms have been used both in the developed and the developing countries in areas of education and health. Overall these mechanisms have shown positive results in terms of improved immunization rates, improved utilization of services such as antenatal care and family planning services, improved quality of care, improved physical conditions of the health facilities etc. The review, nevertheless, revealed some limitations of and risks associated with theses mechanisms. Conclusion This review has shown that result based funding mechanisms have been used both in developed and the developing countries. Moreover the review has also shown that these mechanisms can have a potential to improve MCH services in low income countries. This review has highlighted that CCTs have been relatively more successful demand side mechanisms in improving MCH in the form of improved immunization and antenatal coverage. Contracting has produced mixed results and the literature on SWAPs is still emerging. Moreover in countries with weak and fragile health care delivery systems CCTs can also be tried in tandem with contracting of health services or in areas of poor geographical access these can be experimented with competitive transport vouchers. This however will require time, skill and costs. Political will and futur research based on rigorous methodologies is required to see the long term impacts of these mechanisms on MCH.

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