A new study in BMC Health Services Research examines the impact of incremental facility-level financing on service delivery in Nigeria’s primary health care (PHC) system. Two funding mechanisms were tested —performance-based financing (PBF) and decentralized facility financing (DFF) – and facilities received direct funding, increased budget and spending autonomy, supportive supervision, and community engagement. Researchers used health facility surveys and assessed two outcomes: the breadth of services offered and structural quality.
Results indicated that facilities with more funding (PBF) had the highest service availability, with DFF facilities also outperforming control facilities on most measures. Structural readiness and service offerings both increased with more funding, especially under DFF. Both PBF and DFF facilities were better equipped to provide services they claimed to offer, although this effect was less pronounced for immunization services than for others. PBF’s higher performance was partially explained by higher funding levels.
PBF and DFF both improved the breadth and structural quality of services, although DFF performance was more sensitive to funding levels. Improvements were observed at relatively low levels of incremental funding, but larger investments were associated with better performance. Further, facilities that participated in the study exceeded the performance of control facilities that had similar levels of funding – implying that funding was more valuable in the context of facility decision making autonomy, increased supervision, and community oversight.
Thumbnail image credit: WHO / Blink Media – Etinosa Yvonne
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