The Challenge
In 2012, Senegal’s Ministry of Health and Social Action (MOH), with support from USAID, began piloting a results-based financing (RBF) program for health in two regions. The program works by rewarding the performance of primary-level health centers and supporting district management teams on the basis of meeting targets on coverage of certain priority programs. The reward is also adjusted based on a quality rating at the service delivery level, calculated based on a facility-level quality of care “checklist.”
In early 2013, the RBF program conducted a “review and revision” (R&R) on how the initiative was doing. The key findings from the 2013 R&R demonstrated a need to:
- Gain greater insight on how provider personnel respond to quality incentives
- Revise the current quality tools to ensure their effectiveness (integrating findings from above, as well as additional process and outcome indicators)
- Integrate RBF into additional levels of the health system by developing hospital-level quality assessment instruments
The Opportunity
R4D is working in collaboration with the Netherlands Royal Tropical Institute (KIT) through USAID’s Translating Research into Action (TRAction) program to conduct a study of the quality component of Senegal’s RBF program to address the needs identified by the 2013 R&R. This study is aimed at enhancing the existing primary-level quality checklists, as well as supporting MOH to develop a hospital-level checklist. In addition, the study aims to understand the effect of the program’s quality incentives on service provision. There has been much research conducted on the effectiveness of RBF programs, and on various ways to improve quality of health care; however, few studies have explored the “black box” of how providers’ behaviors change in response to quality incentives.
Our Work
The year-long study, entitled “Study of Enhanced Quality of Care Assessment Instruments in Senegal’s Results-Based Financing Program,” began in May 2015. R4D is focusing on unpacking the “black box” of provider change in response to quality incentives, while KIT is collaborating with MOH and its partners to assess the feasibility of different types of quality indicators, update the existing primary-level quality checklist, and design a hospital-level checklist. The study team is collecting qualitative data through both individual interviews and focus group discussion with providers in intervention (RBF) and control (non-RBF areas).
The results of the study will assist Senegal to arrive at appropriate quality of care instruments and procedures, to apply in the national roll-out of its RBF program, which has recently been expanded to four new regions with support from the World Bank. It will also draw lessons about the use of quality assessment instruments and procedures in the context of RBF that can be adapted and applied in other settings.
