Can payment by results ensure equitable access to contraceptive services? a qualitative case study

International Journal for Equity in Health

Research

Joseph Holden¹  Joyce Mumah²  Heidi Quinn²  Sandra Mudhune²  Barnabas Abok²  Caroline Guinard³  Ginny Robins³  Meghan Bishop⁴  Victoria Boydell⁵ 

[1] Foresight Development Associates, The Greenhouse N16, 49 Green Lanes, N16 9BU, London, UK;International Planned Parenthood Federation, P.O. Box 30234, CVS Plaza, 5Th Floor, Kasuku Road, Off Lenana Road, 00100, Nairobi, Kenya;MSI Reproductive Choices, 1 Conway Street, Fitzroy Square, W1T 6LP, London, UK;Oxford Policy Management, Clarendon House, Cornmarket Street, OH1 3HJ, Oxford, UK;University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK;

关键词: Payment-by-results;    Performance-based financing;    Sexual and reproductive health;    Equity;   

DOI  :  10.1186/s12939-023-01919-1

 received in 2023-02-27, accepted in 2023-05-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Leave No One Behind (LNOB) agenda compels sexual and reproductive health and rights (SRHR) implementers to focus on the multiple and intersecting forms of discrimination and inequalities. One strategy to address these is Payment by Results (PbR). Using the Women’s Integrated Sexual Health (WISH) programme as a case study, this paper examines if and how PbR can ensure equitable reach and impact.MethodsGiven the complexity of PbR mechanisms, a theory-based approach was used in the design and analysis of this evaluation, drawing on four case studies. These were conducted by reviewing global and national programme data and by interviewing 50 WISH partner staff at national level and WISH programme staff at global and regional levels.ResultsThe case studies found that inclusion of equity-based indicators in the PbR mechanism had demonstrable effects on people’s incentives, on how systems work, and on modes of working. The WISH programme was successful in achieving its desired programme indicators. The use of Key Performance Indicators (KPIs) clearly incentivised several strategies for service providers to innovate and reach adolescents and people living in poverty. However, there were trade-offs between performance indicators that increased coverage and others that increased equitable access, as well as several systemic challenges that limited the possible incentive effects.ConclusionsThe use of PbR KPIs incentivised several strategies to reach adolescents and people living in poverty. However, the use of global indicators was too simplistic, resulting in several methodological issues.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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