Impact of Performance-Based Financing in routine vaccination in the health centers of the Bitkine and Melfi Health Districts in the Guera Provincial Health Delegation in Chad

Abstract

The Chad Health System Performance Strengthening Project (PRPSS) 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 routine immunization 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 immunization 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 BCG vaccinations administered at birth, PENTA 1 administered at 6 weeks after birth, PENTA3 administered at 14 weeks after birth, VAR administered at 9 months after birth, PENTA1/PTENTA3 abandonment rate and BCG/VAR abandonment rate for the year 2021 before the PBF project and 2023 after the implementation of the said project. The main independent variables concerned the resources (human, financial and material) to provide vaccination services as defined in the PBF quality grid in Chad. The other independent variables concerned the planning of service provision and supervision. The vaccination coverage rates for BCG, PENTA1, PENTA3, VAR, abandonment in PENTA1/PENTA3, abandonment in BCG/VAR were calculated for the quarters before and after the implementation of the FBP for comparison. Compared to the year 2021, the vaccination coverage rate for BCG, PENTA1, PENTA3, VAR 2023 in the DS of Bitkine and Melfi are showing good progress as well as the abandonment rates for PENTA1/PENTA3 and BCG/VAR.