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Performance-based financing (PBF) verification using facility records alone may lead to overpayment and misreported results. Community verification is crucial for accurate service delivery validation in PBF programs.

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Area of Science:

  • Health economics
  • Public health program evaluation
  • Health systems research

Background:

  • Performance-based financing (PBF) incentivizes healthcare providers based on achieved outcomes.
  • Verification of reported service data is essential for PBF integrity.
  • Current PBF verification often relies heavily on facility records (quantity verification), potentially overlooking service validity.

Purpose of the Study:

  • To assess the extent of verifiability of reported voluntary medical male circumcisions (VMMCs) through facility records and patient interviews.
  • To determine the alignment between facility-level quantity verification and community verification in a PBF program.
  • To explore discrepancies and potential data fabrication in PBF-reported VMMC data.

Main Methods:

  • A mixed-method verification approach combining quantity verification (facility records) and community verification (patient interviews).
  • Analysis of 36,877 VMMCs from DHIS2 for record completeness and 2,010 interviewed patients for data plausibility.
  • Correlation analysis between facility-level performance scores from both verification methods.

Main Results:

  • 94% of facility records for VMMCs were sufficiently complete.
  • Only 55% of selected patients were interviewed, and 17% provided implausible data.
  • No correlation was found between quantity verification and community verification performance scores at the facility level.
  • Verifiers suspected data fabrication and patients providing false contact information.

Conclusions:

  • Quantity verification alone is an inadequate proxy for service delivery accuracy in PBF programs.
  • Relying solely on facility records risks financial overpayment and inaccurate performance reporting.
  • Integrating and enhancing community verification methods is vital for PBF program accountability and effectiveness.