Evaluate the implementation process and effect of performance based financing in the health centers of Jinja diocese: case study centers of Jinja diocese

Abstract

Most of the low and medium income countries are far below their targets as regards the health related Millennium Development Goal and it will be impossible for them to meet their targets by 2015 (World Bank 2008, WHO 2010). In 2005, a concept of universal access to health for all by 2025 was coined by WHO member countries (WHO 2005). This desire for attainment of universal health for all has led to an increased financial support to the developing countries, unfortunately their health care indicators remain poor and their performance does not match with the amount of resources they have received. WHO has asked all stakeholders to look out for ways in which they can stimulate improved performance in health with a view of reaching more people with acceptable quality services (WHO 2010). Performance Based Financing (PBF) has slowly gained ground as one of the provider payment mechanisms that can address the inefficiencies in health. It is being implemented in several countries and experience about its effect on healthcare delivery is building up. A pilot PBF project is being implemented in the health centers of Jinja diocese. However, there is no information about its implementation and what effects it can have on healthcare service delivery in Jinja diocese. Therefore this study was intended to evaluate the implementation process of the PBF project, its effect on the performance of health centers as well as the benefits and challenges faced during the implementation. It was a comparative, descriptive cross sectional study. The study involved interviewing key respondents about the implementation process, the benefits and challenges they were experiencing in the process. Performance data was also collected from the health centers for 2 vi years before and 2 years following PBF introduction. Same data was collected for the same period of time from public health centers that are not involved in PBF. Comparison was then made so as to assess the possible effect of PBF on the performance of the H/Cs. The finding showed that the parallel model of PBF implementation was used within the thin structures in the diocese. There was no creation of new institutional entities that have been accepted as being necessary for the success of PBF. The study noted a positive trend in performance in most of the health centers implementing PBF in comparison with the public health centers but it was very difficult to truly attribute this observation to PBF especially in the absence of the basic institutions to support the implementation process. Some of the benefits the study noted included improved attention to recording and timely submission of facility reports, patient centered facility planning, lowering and flattening of user fee in order to attract more patients to come for the services. While challenges included; understaffing, rising cost of supplies in a wake of desire for the H/Cs to lower user fees, difficult performance targets to attain among others. It was therefore concluded that despite the observed increase in performance of the H/Cs, there is need to streamline the implementation process by creating autonomous entities of local fund holder/steering committee, regulator and verifier. This will give credibility to the process especially when there is a desire to scale up the approach from a small pilot project to a wider coverage involving even the public health sector.