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Boosting facility deliveries with results-based financing: a mixed-methods evaluation of the government midwifery incentive scheme in Cambodia.

Ir P, Korachais C, Chheng K, Horemans D, Van Damme W, Meessen B - BMC Pregnancy Childbirth (2015)

Bottom Line: We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals.The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality.Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health, Ministry of Health, PO BOX 1300, Phnom Penh, Cambodia. ipor@niph.org.kh.

ABSTRACT

Background: Increasing the coverage of skilled attendance at births in a health facility (facility delivery) is crucial for saving the lives of mothers and achieving Millennium Development Goal five. Cambodia has significantly increased the coverage of facility deliveries and reduced the maternal mortality ratio in the last decade. The introduction of a nationwide government implemented and funded results-based financing initiative, known as the Government Midwifery Incentive Scheme (GMIS), is considered one of the most important contributors to this. We evaluated GMIS to explore its effects on facility deliveries and the health system.

Methods: We used a mixed-methods design. An interrupted time series model was applied, using routine longitudinal data on reported deliveries between 2006 and 2011 that were extracted from the health information system. In addition, we interviewed 56 key informants and performed 12 focus group discussions with 124 women who had given birth (once or more) since 2006. Findings from the quantitative data were carefully interpreted and triangulated with those from qualitative data.

Results: We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals. Segmented linear regressions showed that the introduction of GMIS in October 2007 made the increase in facility deliveries and deliveries with skilled attendants significantly jump by 18 and 10% respectively. Results from qualitative data also suggest that the introduction of GMIS together with other interventions that aimed to improve access to essential maternal health services led to considerable improvements in public health facilities and a steep increase in facility deliveries. Home deliveries attended by traditional birth attendants decreased concomitantly. We also outline several operational issues and limitations of GMIS.

Conclusions: The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality. Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.

No MeSH data available.


Related in: MedlinePlus

Impact of results-based financing on location and assistance of deliveries: Observed and predicted values. a) Facility deliveries in districts with no more other major financing intervention than GMIS. b) Facility deliveries in districts with one or more other major financing intervention than GMIS. c) Facility deliveries in all districts. d) All deliveries by trained health personnel in all districts
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Fig1: Impact of results-based financing on location and assistance of deliveries: Observed and predicted values. a) Facility deliveries in districts with no more other major financing intervention than GMIS. b) Facility deliveries in districts with one or more other major financing intervention than GMIS. c) Facility deliveries in all districts. d) All deliveries by trained health personnel in all districts

Mentions: Model (1) in column one was performed on the data of 19 health districts which had no other major health financing scheme, such as contracting, health equity funds, vouchers, etc. The coefficient of the constant indicates that at the beginning of the period of observation, in this sub-region of Cambodia, there were on average 611 facility deliveries per month (p-value <0.01). There was a significant upward trend with an average of 36 more facility deliveries each month (p-value <0.01). Model (1) also shows that immediately after the intervention, the number of facility deliveries increased suddenly and significantly by 490 deliveries per month (p-value <0.01), but there was no significant change in the month-to-month trend (p-value >0.1). According to this data, the number of facility deliveries in October 2007 (the first month after the start of the intervention) was around 1,897, while it would have been 1,408 without the intervention, suggesting an increase in facility deliveries by 35 % the first month. Similarly, we estimate that the number of facility deliveries 12 months after the intervention was around 27 % higher than it would have been without the intervention. Figure 1a presents the raw data series of the outcome of interest, and the fitted results obtained from Model (1).Fig. 1


Boosting facility deliveries with results-based financing: a mixed-methods evaluation of the government midwifery incentive scheme in Cambodia.

Ir P, Korachais C, Chheng K, Horemans D, Van Damme W, Meessen B - BMC Pregnancy Childbirth (2015)

Impact of results-based financing on location and assistance of deliveries: Observed and predicted values. a) Facility deliveries in districts with no more other major financing intervention than GMIS. b) Facility deliveries in districts with one or more other major financing intervention than GMIS. c) Facility deliveries in all districts. d) All deliveries by trained health personnel in all districts
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537578&req=5

Fig1: Impact of results-based financing on location and assistance of deliveries: Observed and predicted values. a) Facility deliveries in districts with no more other major financing intervention than GMIS. b) Facility deliveries in districts with one or more other major financing intervention than GMIS. c) Facility deliveries in all districts. d) All deliveries by trained health personnel in all districts
Mentions: Model (1) in column one was performed on the data of 19 health districts which had no other major health financing scheme, such as contracting, health equity funds, vouchers, etc. The coefficient of the constant indicates that at the beginning of the period of observation, in this sub-region of Cambodia, there were on average 611 facility deliveries per month (p-value <0.01). There was a significant upward trend with an average of 36 more facility deliveries each month (p-value <0.01). Model (1) also shows that immediately after the intervention, the number of facility deliveries increased suddenly and significantly by 490 deliveries per month (p-value <0.01), but there was no significant change in the month-to-month trend (p-value >0.1). According to this data, the number of facility deliveries in October 2007 (the first month after the start of the intervention) was around 1,897, while it would have been 1,408 without the intervention, suggesting an increase in facility deliveries by 35 % the first month. Similarly, we estimate that the number of facility deliveries 12 months after the intervention was around 27 % higher than it would have been without the intervention. Figure 1a presents the raw data series of the outcome of interest, and the fitted results obtained from Model (1).Fig. 1

Bottom Line: We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals.The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality.Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health, Ministry of Health, PO BOX 1300, Phnom Penh, Cambodia. ipor@niph.org.kh.

ABSTRACT

Background: Increasing the coverage of skilled attendance at births in a health facility (facility delivery) is crucial for saving the lives of mothers and achieving Millennium Development Goal five. Cambodia has significantly increased the coverage of facility deliveries and reduced the maternal mortality ratio in the last decade. The introduction of a nationwide government implemented and funded results-based financing initiative, known as the Government Midwifery Incentive Scheme (GMIS), is considered one of the most important contributors to this. We evaluated GMIS to explore its effects on facility deliveries and the health system.

Methods: We used a mixed-methods design. An interrupted time series model was applied, using routine longitudinal data on reported deliveries between 2006 and 2011 that were extracted from the health information system. In addition, we interviewed 56 key informants and performed 12 focus group discussions with 124 women who had given birth (once or more) since 2006. Findings from the quantitative data were carefully interpreted and triangulated with those from qualitative data.

Results: We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals. Segmented linear regressions showed that the introduction of GMIS in October 2007 made the increase in facility deliveries and deliveries with skilled attendants significantly jump by 18 and 10% respectively. Results from qualitative data also suggest that the introduction of GMIS together with other interventions that aimed to improve access to essential maternal health services led to considerable improvements in public health facilities and a steep increase in facility deliveries. Home deliveries attended by traditional birth attendants decreased concomitantly. We also outline several operational issues and limitations of GMIS.

Conclusions: The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality. Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.

No MeSH data available.


Related in: MedlinePlus