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Performance-based financing for improving HIV/AIDS service delivery: a systematic review.
Amitabh B Suthar1, Jason M Nagata2, Sabin Nsanzimana3,4
1Department of HIV/AIDS, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland. amitabh.suthar@gmail.com.
BMC Health Services Research
|January 6, 2017
Summary
Performance-based financing (PBF) shows promise for improving HIV/AIDS service delivery, particularly in increasing antiretroviral coverage and reducing treatment failures. Further research is needed to address remaining knowledge gaps in health systems and governance.
Area of Science:
- Public Health
- Health Systems Strengthening
- HIV/AIDS Research
Background:
- International HIV/AIDS financing has plateaued, necessitating efficient resource utilization.
- Performance-based financing (PBF) is an incentive mechanism to improve health system performance.
- This review informs World Health Organization (WHO) guidelines on PBF for HIV/AIDS services.
Purpose of the Study:
- To systematically review the effects of performance-based financing (PBF) on HIV/AIDS service delivery.
- To evaluate PBF's impact on service quality, access, and cost in HIV/AIDS programs.
- To identify knowledge gaps for future research and policy development.
Main Methods:
- Systematic review of randomized trials, comparative contemporaneous studies, and time-series studies.
- Searches conducted in PubMed, WHO Index Medicus, conference databases, and clinical trial registries (April 2015).
- Inclusion criteria: studies evaluating PBF in people with HIV reporting on service quality, access, or cost.
Main Results:
- Four studies from Sub-Saharan Africa (173,262 participants) met eligibility criteria.
- PBF improved couples and pregnant women testing coverage, antiretroviral coverage for pregnant women, infants, and adults.
- PBF reduced attrition and treatment failure; no potential harms were reported.
Conclusions:
- Limited data suggests PBF positively impacts HIV service access and quality.
- Critical knowledge gaps in health system and governance aspects of PBF remain.
- Further research is essential to inform national policymaking for effective HIV/AIDS interventions.
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