Does Performance-Based Financing Improve Assisted Deliveries in Health Centers in the Bitkine and Melfi Health Districts in the Guera Provincial Health Delegation in Chad?

Abstract

The Health System Performance Strengthening Project (PRPSS) in Chad focuses primarily on improving the delivery of essential health care services through institutional capacity building and the institutionalization of Performance-Based Financing (PBF), building on lessons learned from the Maternal and Child Health Services Strengthening Project and other World Bank operations in Chad. The objective of this study is to analyze the impact of PBF on assisted delivery performance in Health Centers in two Health Districts (Bitkine & Melfi) of the Guera Provincial Health Delegation. The study conducted is a retrospective evaluation adapted to the intervention evaluation framework of reproductive health services in the different health centers of the Districts of Bitkine and Melfi before and after the implementation of performance-based financing. A total of 36 functional health facilities from the beginning to the end of the experience were included. The dependent variable (DV) was the quarterly number of assisted deliveries in 2021 before the PBF project and in 2023 after the implementation of the project. The main independent variables concerned the resources (human, financial and material) to provide assisted delivery services as defined in the PBF quality grid in Chad. The other independent variables concerned supply planning, supervision, compliance with reference procedures and monitoring and care protocols administered. The coverage rates of assisted deliveries, obstetric case referrals, maternal deaths as well as stillbirths and macerated births were calculated for the quarters before and after the implementation of the PBF for comparison. Compared to the year 2021, the rate of assisted deliveries in 2023 in the DS of Bitkine almost doubled during all four quarters of the year. Although still far from 90% of the target, it should be noted that progress is good. In Melfi's DS, we see that the rate of assisted births has doubled compared to 2021 and 2023, with a better progression.