Trial reportBulletin of the World Health Organization2018
Cost-effectiveness of results-based financing, Zambia: a cluster randomized trial.
Trial report in Bulletin of the World Health Organization, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 5 syntheses or guidelines pooled it, 49 citations in OpenAlex.
- Health technology assessment to support health benefits package design: a systematic review of economic evaluation evidence in Zambia.BMC health services research · 2024Pooled it
- Behavioral interventions for vaccination uptake: A systematic review and meta-analysis.Health policy (Amsterdam, Netherlands) · 2023Pooled it
- Evaluations of effective coverage of maternal and child health services: A systematic review.Health policy and planning · 2022Pooled it
- Paying for performance to improve the delivery of health interventions in low- and middle-income countries.The Cochrane database of systematic reviews · 2021Pooled it
- How can human resources for health interventions contribute to sexual, reproductive, maternal, and newborn healthcare quality across the continuum in low- and lower-middle-income countries? A systematic review.Human resources for health · 2021Pooled it
- Economic evaluation of financial incentives for maternal and child health in the Democratic Republic of the Congo (DRC): a decision-tree modelling based on a cluster randomized controlled trial.Global health research and policy · 2025Trial
- The cost-effectiveness of using performance-based financing to deliver the basic package of health services in Afghanistan.BMJ global health · 2020Trial
- The impact of the single contract on health service delivery in the Democratic Republic of the Congo (DRC): findings from a quasi-experimental study.npj health systems · 2025Article
- The effect of performance-based financing interventions on health worker motivation and job satisfaction: experimental evidence from six national pilots.Health policy and planning · 2025Article
- Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger.Human resources for health · 2024Article
- Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.PloS one · 2024Article
- Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review.BMJ open · 2023Article
- Can payment by results ensure equitable access to contraceptive services? a qualitative case study.International journal for equity in health · 2023Article
- Exploring the roles of players in strategic purchasing for healthcare in Africa-a scoping review.Health policy and planning · 2023Article
- How much does effective health facility inspection cost? An analysis of the economic costs of Kenya's Joint Health Inspection innovations.BMC health services research · 2022Article
- Universal health coverage and the poor: to what extent are health financing policies making a difference? Evidence from a benefit incidence analysis in Zambia.BMC public health · 2022Article
- Article
- Use of implementation science to advance family planning programs in low- and middle-income countries: A systematic review.Frontiers in global women's health · 2022Review
- The effects of performance-based financing on neonatal health outcomes in Burundi, Lesotho, Senegal, Zambia and Zimbabwe.Health policy and planning · 2021Article
- The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi.BMJ global health · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the cost-effectiveness of results-based financing and input-based financing to increase use and quality of maternal and child health services in rural areas of Zambia.
methodsIn a cluster-randomized trial from April 2012 to June 2014, 30 districts were allocated to three groups: results-based financing (increased funding tied to performance on pre-agreed indicators), input-based financing (increased funding not tied to performance) or control (no additional funding), serving populations of 1.33, 1.26 and 1.40 million people, respectively. We assessed incremental financial costs for programme implementation and verification, consumables and supervision. We evaluated coverage and quality effectiveness of maternal and child health services before and after the trial, using data from household and facility surveys, and converted these to quality-adjusted life years (QALYs) gained.
findingsCoverage and quality of care increased significantly more in results-based financing than control districts: difference in differences for coverage were 12.8% for institutional deliveries, 8.2% postnatal care, 19.5% injectable contraceptives, 3.0% intermittent preventive treatment in pregnancy and 6.1% to 29.4% vaccinations. In input-based financing districts, coverage increased significantly more versus the control for institutional deliveries (17.5%) and postnatal care (13.2%). Compared with control districts, 641 more lives were saved (lower-upper bounds: 580-700) in results-based financing districts and 362 lives (lower-upper bounds: 293-430) in input-based financing districts. The corresponding incremental cost-effectiveness ratios were 809 United States dollars (US$) and US$ 413 per QALY gained, respectively.
conclusionCompared with the control, both results-based financing and input-based financing were cost-effective in Zambia.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.