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Assessing the impact of using performance-based financing to improve the quality of obstetric and neonatal care in Malawi.

Principal investigator: Manuela De Allegri, IPH Heidelberg

Project Scientific Coordination: Stephan Brenner, IPH Heidelberg

Funding: TRAction (USAID)

Prof. Till Baernighausen and Prof. Tom Bossert, Harvard School of Public Health, USA
Prof. Adamson Muula and Prof. Don Mathanga, College of Medicine, Malawi 

Project description:
Scaling-up of performance-based financing (PBF) schemes across sub-Saharan Africa (SSA) has developed rapidly over the past few years. Although studies in several countries have suggested that PBF can play a role in improving service coverage, a substantial knowledge gap remains as to how various PBF interventions affect quality of care of Essential Obstetric and Newborn Care (EONC).

This study sets to fill this gap in knowledge by providing an independent scientific assessment of both the expected and unexpected effects on quality of maternal care services of a series of PBF interventions being implemented in Malawi. This study aims to assess the quality impact both on the interventions directly targeted by the PBF program (i.e. delivery services) and on the complete range of other relevant maternal and child care services (antenatal, postnatal, and newborn care).

The study is prospective, working for three years alongside the implementation of a relevant PBF program in Malawi, and adopts a controlled before and after triangulation study design. The controlled before and after component refers to the fact that information is collected both from intervention facilities (i.e. facilities enrolled in QPC in the intervention districts) and from control facilities (i.e. facilities not enrolled in QPC in the intervention districts and facilities in the control districts) both before and after each single PBF intervention is rolled out. The triangulation component refers to the inclusion of both quantitative and qualitative data collection and analysis methods. The rationale for such a design rests on the awareness that quality of care is a complex entity, which cannot be captured exclusively quantitatively. It follows that the study adopts a definition of quality that considers quality as the result of the interaction between structural, process, and experiential elements coming together during the provider-patient encounter. Accordingly, we assess quality along all three dimensions: (1) structural elements, i.e. availability of equipment, drugs, staff; (2) process elements, i.e. providers’ compliance with national and international standards; (3) experiential elements, i.e. meeting both providers’ and clients’ expectations on service delivery.

In line with the triangulation study design, the answer to the research question will emerge from the joint appraisal and interpretation of quantitative and qualitative data contributed by the single study components. 

Status: ongoing

Manuela De Allegri (manuela.de.allegri@urz.uni-heidelberg.de)
Stephan Brenner (stephan.brenner@uni-heidelberg.de)