| dc.description.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
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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. | en_US |
