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Does performance-based financing curb stock-outs of essential medicines? Results from a randomised controlled trial

Isidore Sieleunou1,2,3, Manuela De Allegri4, Pascal Roland Enok Bonong2

  • 1University of Montreal Public Health Research Institute, Montreal, QC, Canada.

Tropical Medicine & International Health : TM & IH
|May 24, 2020
PubMed

Insights

Cameroon's performance-based financing (PBF) scheme had no impact on most essential medicines availability. However, PBF significantly reduced stock-outs of family planning medicines, particularly in rural areas.

Area of Science:

  • Health economics
  • Public health policy
  • Pharmaceutical supply chain management

Background:

  • Cameroon introduced a performance-based financing (PBF) scheme in 2011 to improve healthcare.
  • Understanding the impact of PBF on essential medicines (EM) availability is crucial for public health.

Purpose of the Study:

  • This study evaluated the effect of Cameroon's PBF intervention on the availability of essential medicines.

Main Methods:

  • A randomized controlled trial was conducted across 205 health facilities in three regions.
  • Data were collected at baseline (2012) and 36 months later, analyzing stock-outs over 30 days.
  • Difference-in-difference regression models adjusted for covariates were used to estimate PBF's impact.

Main Results:

  • The PBF intervention showed no significant effect on stock-outs for antenatal care drugs, vaccines, childhood illness drugs, or labor and delivery drugs.
  • A significant 34% reduction in stock-outs of family planning medicines was observed (P=0.028).
  • Effect heterogeneity was noted, with greater reductions in family planning medicine stock-outs in the North-West region and rural areas.

Conclusions:

  • The PBF intervention in Cameroon had limited success in reducing overall essential medicines stock-outs.
  • Partial implementation failures, including service disruptions and payment delays, likely contributed to the limited impact.
  • Targeted improvements in family planning medicine availability were observed, suggesting potential for specific PBF successes.
Abstract

Keywords:
Cameroonavailabilityessential medicinesperformance-based financingrandomised control studystock-outs

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