ArticleHealth policy and planning2021
The effects of performance-based financing on neonatal health outcomes in Burundi, Lesotho, Senegal, Zambia and Zimbabwe.
Article in Health policy and planning, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effects of different payment methods on perinatal care outcomes: a systematic review.BMC health services research · 2025Pooled it
- Determinants of neonatal mortality at Kamenge Teaching Hospital, Burundi: a prospective cohort study.BMC public health · 2025Article
- Financing surgery in LMICs: building sustainable and equitable systems for universal surgical access - a narrative review.BMC surgery · 2025Review
- Countdown to 2030: overview of current and planned health financing reforms for universal health coverage in the WHO African Region.Journal of global health · 2025Article
- The effects of decentralized financing and funding levels on the breadth of services and structural quality to provide those services in primary health facilities in Nigeria.BMC health services research · 2025Article
- Activity-based contracting for optimization of the mass distribution of insecticide-treated nets in the Democratic Republic of Congo: pilot implementation in Kwilu province.BMC public health · 2024Article
- Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.PloS one · 2024Article
- The politics of health system quality: how to ignite demand.BMJ (Clinical research ed.) · 2023Article
- Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review.BMJ open · 2023Article
- The impact of performance-based financing within local health systems: Evidence from Mozambique.Health economics · 2023Article
- Maternal mortality study in the Eastern Democratic Republic of the Congo.BMC pregnancy and childbirth · 2022Article
- Dying to know: does performance-based financing reduce mortality?Health policy and planning · 2022Article
- Seizing the moment to rethink health systems.The Lancet. Global health · 2021Article
- Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe.Social science & medicine (1982) · 2021Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Maternal and newborn care has been a primary focus of performance-based financing (PBF) projects, which have been piloted or implemented in 21 countries in sub-Saharan Africa since 2007. Several evaluations of PBF have demonstrated improvements to facility delivery or quality of care. However, no studies have measured the impact of PBF programmes directly on neonatal health outcomes in Africa, nor compared PBF programmes against another. We assess the impact of PBF on early neonatal health outcomes and associated health care utilization and quality in Burundi, Lesotho, Senegal, Zambia and Zimbabwe. We pooled Demographic and Health Surveys and Multiple Indicator Cluster Surveys and apply difference-in-differences analysis to estimate the effect of PBF projects supported by the World Bank on early neonatal mortality and low birthweight. We also assessed the effect of PBF on intermediate outputs that are frequently explicitly incentivized in PBF projects, including facility delivery and antenatal care utilization and quality, and caesarean section. Finally, we examined the impact among births to poor or high-risk women. We found no statistically significant impact of PBF on neonatal health outcomes, health care utilization or quality in a pooled sample. PBF was also not associated with better health outcomes in each country individually, though in some countries and among poor women PBF improved facility delivery, antenatal care utilization or antenatal care quality. There was no improvement on the health outcomes among poor or high-risk women in the five countries. PBF had no impact on early neonatal health outcomes in the five African countries studied and had limited and variable effects on the utilization and quality of neonatal health care. These findings suggest that there is a need for both a deeper assessment of PBF and for other strategies to make meaningful improvements to neonatal health outcomes.
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