Evaluation of the Unintended Consequences of an Intervention Combining Performance-Based Financing with Health Equity in Burkina Faso

Date: April 22, 2015
Times: 13h00 to 14h15 Eastern Time (Montréal)
Presenter: Anne-Marie Turcotte-Tremblay
Background:  Access to healthcare services remains inadequate in Burkina Faso. Thus, national authorities are implementing a complex intervention that combines performance-based financing (PBF) with community-based health insurance (CBHI) and pro-poor targeting. Although some studies suggest promising results, the body of evidence on the unintended consequences of PBF is not well established. For example, financial incentives may erode intrinsic motivation or lead to the neglect of non-incentivized services. Other risks include a decrease in the quality of care, the manipulation of performance data, and the provision of services to easily accessible populations. Thus, there is an urgent need to examine if the intervention causes unintended consequences.
Objectives: First, we will conduct a systematic review of the literature on the unintended consequences of PBF in low-income countries. Then, we will examine, from empirical data, whether the implementation of the different components of the intervention in Burkina Faso resulted in unintended effects over time.
Methods: The scoping review will follow the guidelines proposed for mixed methods reviews. . For the empirical research, healthcare centers will be selected to conduct in-depth case studies using multiple sources of quantitative and qualitative data (ex., administrative data, semi-structured interviews and observations). QDA Minor will be used for content analysis of the qualitative data. Time series analyses will be conducted to compare the evolution of incentivised versus non-incentivized services over time.
Findings: We expect that the financial incentives will erode intrinsic motivation and lead to the neglect of non-incentivized healthcare services. We also expect that the intervention will cause an increase in inequity,  a decrease in the quality of care and the manipulation of performance data.
Discussion questions: Which theories are best suited to study the unintended consequences of population health intervention research? Can we infer causality using the proposed methodology? How can we increase the generalizability of the results? How can we ensure that the results will be pertinent for decision makers while maintaining our independence as researchers?