The Impact of Performance-Based Funding on the Quality of care in the Gemena Health District (Congo): A Mixed‑Methods Before‑After Study
Effet du Financement Basé sur la Performance sur la Qualité de Soins de Santé dans la Zone de Santé de Gemena (Congo): Une Étude Mixte Avant‑Après
DOI:
https://doi.org/10.5281/zenodo.19630913Keywords:
Performance-based funding, Quality of care, GemenaAbstract
RESUME
Introduction. Le financement basé sur la performance (FBP) a été introduit dans certaines zones de santé de la République Démocratique du Congo, mais ses effets concrets sur la qualité des soins ont été rarement évalués de façon rigoureuse. Cette étude a évalué l’effet du FBP sur la qualité des soins dans la Zone de santé de Gemena, identifié les facteurs limitant son efficacité et comparé la qualité avant et après sa mise en œuvre. Méthodes. Une étude à approche mixte (quantitative et qualitative) a été menée de janvier à juin 2025. L’enquête quantitative a inclus 315 usagers des services de santé, et des entretiens qualitatifs ont été réalisés auprès de 10 à 20 professionnels de santé jusqu’à saturation des informations. Les dimensions de la qualité (efficacité, sécurité, rapidité, équité, continuité, intégration, efficience) ont été mesurées avant et après l’introduction du FBP. Une régression logistique a identifié les déterminants de l’amélioration. Résultats. Après mise en œuvre du FBP, la qualité s’est améliorée significativement pour six dimensions sur sept, avec des gains les plus marqués pour l’efficacité (+20,2 %), la sécurité (+19,2 %) et la rapidité (+20,9 %). L’équité n’a pas progressé de façon significative (+6,5 % ; p = 0,090). Le respect des indicateurs contractuels (OR = 2,71), les incitations financières régulières (OR = 2,45) et la régularité des paiements (OR = 1,98) étaient les principaux déterminants de l’amélioration. Les données qualitatives ont révélé des facteurs limitants : retards de paiement (72 %), manque d’équipements (68 %) et insuffisance des montants incitatifs (65 %). Conclusion. Le FBP améliore significativement la qualité technique et organisationnelle des soins à Gemena, mais son efficacité est freinée par des retards de paiement et des ressources insuffisantes. Renforcer la disponibilité des intrants et la régularité des incitations est essentiel pour maximiser son impact.
ABSTRACT
Introduction. Performance‑based financing (PBF) has been introduced in some health zones of the Democratic Republic of Congo, but its concrete effects on care quality have rarely been rigorously evaluated. This study assessed the effect of PBF on care quality in the Gemena health zone, identified factors limiting its effectiveness, and compared quality before and after implementation. Methods. A mixed‑methods study (quantitative and qualitative) was conducted from January to June 2025. The quantitative survey included 315 health service users, and qualitative interviews were conducted with 10 to 20 health professionals until data saturation. Quality dimensions (effectiveness, safety, timeliness, equity, continuity, integration, efficiency) were measured before and after PBF introduction. Logistic regression identified determinants of improvement. Results. After PBF implementation, quality improved significantly for six out of seven dimensions, with the largest gains for effectiveness (+20.2%), safety (+19.2%), and timeliness (+20.9%). Equity did not improve significantly (+6.5%; p = 0.090). Respect for contractual indicators (OR = 2.71), regular financial incentives (OR = 2.45), and payment regularity (OR = 1.98) were the main determinants of improvement. Qualitative data revealed limiting factors: payment delays (72%), lack of equipment (68%), and insufficient incentive amounts (65%). Conclusion. PBF significantly improves technical and organizational care quality in Gemena, but its effectiveness is hampered by payment delays and insufficient resources. Strengthening input availability and incentive regularity is essential to maximize its impact.
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