Evaluation de l'approche Financement Basé sur la Performance: Cas de l'Hôpital Régional d'Edéa

Public health, University of Yaounde 1
June, 2014
Young cameroonian woman, native of the Littoral region. Christian enganged to teach to the youth true value of life, to be a model in the society and to serve others.


Introduction: Performance Based Financing (PBF) is a strategy which aims to improve the quantity and quality of health care. In our work, the question was: what are the changes observed in health care delivery since the introduction of PBF in the Edea Regional Hospital. The hypothesis was that the PBF has quantitatively and qualitatively improved health care delivery in the Edea Regional Hospital.

Objectives: Our main aim was to evaluate the state of health care delivery in the Edea Regional Hospital depending on the introduction of PBF. Specifically, we had to describe and compare the organization of health care delivery, to evaluate the yield and to describe and compare the perception of healthcare quality by recipients before and after introduction of PBF in the Edea Regional Hospital.

Methodology: We did an evaluative study with a before-after design, carried out at the Edea Regional Hospital during 3 months, from December 2013 to February 2014. For an evaluation corresponding to a period of 3 years from the 1st January 2011 to the 31st December 2013. After obtaining authorizations, we recruited any maternal health service and any communicable diseases service existing in the Edea Regional Hospital since at least January 2011 and included in PBF since its introduction in the hospital. We excluded any maternal health service and any communicable diseases service not included in complementary package of activities and/or with unusable medical activity report for the study period. Data were collected, firstly by reviewing medical activity reports, performance declaration/ validation forms and quality evaluation forms. Then with the recipients and care providers. Analysis was performed using Epi info version 3.4.5 and SPSS version 20 software, with a margin of error of 6%, a confidence interval of 95% and a significance level α=0.05.

Results: Regarding organization of health care delivery at the hospital, a proportion of 59.1% found the planning of activities good during the period following the introduction of PBF against 56.8% before. The monetary motivation was the most important for 55.9%. Concerning the yield of the hospital, an increase of financial incomes was noticed, as well as that of health indicators such as a 100% increase for the indicator “number of pregnant woman who took the IPT 1 or 2 or 3”. The quality score increased by 38% following the introduction of PBF. However, during the period of PBF, indicators were not growing and almost no target has been reached. Finally, satisfaction of the health care quality received was very good for 93% of the 96.5% satisfied recipients. Furthermore, the influence of fear of sanctions on heath workers productivity, reflected a lack of understanding of PBF issue and a lack of program ownership. In addition, an evident lack of knowledge of the program reveals that the program was inadequately transmitted and the inconsideration of the program by the providers.

Conclusion: The answer to our research question was that quantitative and qualitative progress of health care delivery is significant after the introduction of PBF. But, these changes could not be attributed to PBF only and the notion of PBF effectiveness is still unknown.

Recommendations: To health facilities applying PBF, to re-organize training for health workers to inform them on the issue of PBF; to initiate for health workers quarterly training on PBF, to initiate institutional assessment surveys for providers several times a year; to introduce systematical satisfaction survey on the quality of care, for each external and internal user.

Key words : Financing, Performance, Evaluation, Effectiveness, Delivery, Edea