[ Un financement basé sur la performance influence-t-il réellement l’utilisation des services de santé de première ligne en milieu rural africain ? ]
Volume 38, Issue 3, January 2023, Pages 710–718
Hermès Karemere1, Patient Batasema Kahora2, Jean Ahana3, and Johanna Karemere4
1 Ecole régionale de Santé Publique, Université catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
2 Faculté de Médecine et de Pharmacie, département de Santé Publique, Université officielle de Bukavu, Bukavu, Sud-Kivu, RD Congo
3 Faculté de Médecine et de Pharmacie, département de Santé Publique, Université officielle de Bukavu, Bukavu, Sud-Kivu, RD Congo
4 Chercheure indépendante, Bureau de Kinshasa, Kinshasa, Gombe, RD Congo
Original language: French
Copyright © 2023 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction: The performance-based financing approach was deployed in the Health Zone (ZS) of Miti-Murhesa between 2009 and 2014 by the « Agence d’Achat des Performances » (AAP) South Kivu. This study analyzes whether such an approach can really influence the use of health services. Methods: This is a quasi-experimental evaluation («before-after» study), adapted to the program intervention evaluation framework, using a documentary review and individual interviews that targeted 345 people, including 246 users care services and 99 health care workers. Thematic analysis of the data was applied and concerned the socio-demographic characteristics of the respondents, their perceptions of the program impact, the use of services before and during the program and the use of therapeutic alternatives before and during the program. Results: The proportion of people declaring use of health services in the Health Zone increased from 59% before the program to 93% at the end of the program (n=246). During the program implementation, the number of people who resorted to self-medication, the prayer room or witch doctors decreased, respectively from 126 (i.e. 51.2%) to 55 (i.e. 21.9%); from 9 (i.e. 3.6%) to 6 (i.e. 2.4%) and from 6 (i.e. 2.4%) to 2 (i.e. 0.8%) while that of people who had recourse to traditional healers increased significantly by 24 (9.7%) to 114 (46.3%). The population recognized the positive effects of the performance-based financing (PBF) program of AAP Sud-Kivu. Concerning the perception of the facilitators of the Health Zone, 94% (n=99) attest that the program has motivated the staff, has favored the improvement of the quality of services and has favored the realization of home visits. The lack of care for certain pathologies, including chronic ones such as tuberculosis, is deplored. Conclusion: Performance-based financing can actually improve the use of frontline care services by reducing care costs and improving the quality of services. However, recourse to traditional healers remains the most competitive therapeutic alternative to the care offered by the integrated health structures of the ZS of Miti-Murhesa. This study recommends a sustainability plan for each performance-based financing program and effective regulation of the practice of traditional healers.
Author Keywords: Performance-based financing, utilization of health services, health zone, Miti-Murhesa, Democratic Republic of Congo.
Volume 38, Issue 3, January 2023, Pages 710–718
Hermès Karemere1, Patient Batasema Kahora2, Jean Ahana3, and Johanna Karemere4
1 Ecole régionale de Santé Publique, Université catholique de Bukavu, Bukavu, Sud-Kivu, RD Congo
2 Faculté de Médecine et de Pharmacie, département de Santé Publique, Université officielle de Bukavu, Bukavu, Sud-Kivu, RD Congo
3 Faculté de Médecine et de Pharmacie, département de Santé Publique, Université officielle de Bukavu, Bukavu, Sud-Kivu, RD Congo
4 Chercheure indépendante, Bureau de Kinshasa, Kinshasa, Gombe, RD Congo
Original language: French
Copyright © 2023 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Introduction: The performance-based financing approach was deployed in the Health Zone (ZS) of Miti-Murhesa between 2009 and 2014 by the « Agence d’Achat des Performances » (AAP) South Kivu. This study analyzes whether such an approach can really influence the use of health services. Methods: This is a quasi-experimental evaluation («before-after» study), adapted to the program intervention evaluation framework, using a documentary review and individual interviews that targeted 345 people, including 246 users care services and 99 health care workers. Thematic analysis of the data was applied and concerned the socio-demographic characteristics of the respondents, their perceptions of the program impact, the use of services before and during the program and the use of therapeutic alternatives before and during the program. Results: The proportion of people declaring use of health services in the Health Zone increased from 59% before the program to 93% at the end of the program (n=246). During the program implementation, the number of people who resorted to self-medication, the prayer room or witch doctors decreased, respectively from 126 (i.e. 51.2%) to 55 (i.e. 21.9%); from 9 (i.e. 3.6%) to 6 (i.e. 2.4%) and from 6 (i.e. 2.4%) to 2 (i.e. 0.8%) while that of people who had recourse to traditional healers increased significantly by 24 (9.7%) to 114 (46.3%). The population recognized the positive effects of the performance-based financing (PBF) program of AAP Sud-Kivu. Concerning the perception of the facilitators of the Health Zone, 94% (n=99) attest that the program has motivated the staff, has favored the improvement of the quality of services and has favored the realization of home visits. The lack of care for certain pathologies, including chronic ones such as tuberculosis, is deplored. Conclusion: Performance-based financing can actually improve the use of frontline care services by reducing care costs and improving the quality of services. However, recourse to traditional healers remains the most competitive therapeutic alternative to the care offered by the integrated health structures of the ZS of Miti-Murhesa. This study recommends a sustainability plan for each performance-based financing program and effective regulation of the practice of traditional healers.
Author Keywords: Performance-based financing, utilization of health services, health zone, Miti-Murhesa, Democratic Republic of Congo.
Abstract: (french)
Introduction: L’approche du financement basé sur la performance a été déployée dans la Zone de santé (ZS) de Miti-Murhesa entre 2009 et 2014 par l’Agence d’Achat des Performances « AAP » Sud-Kivu. La présente étude analyse si une telle approche peut réellement influencer l’utilisation des services de santé. Méthodes: Il s’agit d’une évaluation quasi-expérimentale (étude « avant-après »), adaptée au cadre d’évaluation d’intervention des programmes, recourant à la revue documentaire et aux entrevues individuelles ayant ciblé 345 personnes dont 246 utilisateurs des services de soins et 99 animateurs de la ZS. L’analyse thématique des données a été appliquée et a concerné les caractéristiques sociodémographiques des personnes interrogées, leurs perceptions sur l’impact du programme, l’utilisation des services avant et pendant le programme et l’utilisation des alternatives thérapeutiques avant et pendant le programme. Résultats: La proportion des personnes déclarant recourir aux services de santé de la Zone de santé est passée de 59% avant le programme à 93% à la fin du programme (n=246). Durant la mise en œuvre du programme, le nombre de personnes ayant recouru à l’automédication, à la chambre de prière ou aux féticheurs a baissé, respectivement de 126 (soit 51,2%) à 55 (soit 21,9 %); de 9 (soit 3,6%) à 6 (soit 2,4%) et de 6 (soit 2,4%) à 2 (soit 0,8%) tandis que celui de personnes ayant recouru aux tradipraticiens a sensiblement augmenté de 24 (soit 9,7%) à 114 (soit 46,3%). La population a reconnu des effets positifs du programme de financement basé sur la performance (FBP) de l’AAP Sud-Kivu. Concernant la perception des animateurs de la Zone de santé 94% (n=99) attestent que le programme a motivé le personnel, a favorisé l’amélioration de la qualité des services et a favorisé la réalisation des visites à domicile. L’absence de la prise en charge de certaines pathologies dont celles chroniques comme la tuberculose est déplorée. Conclusion: Le financement basé sur la performance peut réellement améliorer l’utilisation des services de première ligne des soins grâce à la réduction des coûts des soins et l’amélioration de la qualité des services. Le recours aux tradipraticiens demeure cependant l’alternative thérapeutique la plus concurrentielle aux soins offerts par les structures sanitaires intégrées de la ZS de Miti-Murhesa. La présente étude recommande un plan de pérennisation pour chaque programme de financement basé sur la performance et une régulation efficace de la pratique des tradipraticiens.
Author Keywords: Financement basé sur la performance, utilisation des services de santé, zone de santé, Miti-Murhesa, République démocratique du Congo.
How to Cite this Article
Hermès Karemere, Patient Batasema Kahora, Jean Ahana, and Johanna Karemere, “Does performance-based financing really influence the use of frontline health services in rural Africa?,” International Journal of Innovation and Applied Studies, vol. 38, no. 3, pp. 710–718, January 2023.
