A Study on the Factors that Influence Performance-Based Financing toward Universal Health Coverage in Muramvya Province of Burundi

Abstract

Introduction: Under the same goal to advance toward Universal Health Coverage and after evidence from international non-governmental organizations and Rwanda's experience, performance-based financing (PBF) has been introduced in low and middle-income countries, primarily in Africa, including Burundi. Available evidence showed a mixed result from the PBF scheme with an increase of most contracted services and no increase of non-contracted services. However, many health experts have considered PBF a pillar of strengthening the Burundi health system. Moreover, some evidence revealed a possible adverse effect of PBF to weaken the health system. Purpose: We aimed to study the Factors that Influence Performance-Based Financing toward Universal Health Coverage in Muramvya Province of Burundi. Materials and Methods: We conducted a cross-sectional study to investigate the factors influencing performance-based financing toward universal health coverage in Muramvya province of Burundi. We used an online self-administrative questionnaire tool that included socio-demographic characteristics, satisfaction on PBF implementation, and its effect on health service coverage and the number of services provided. Results: Results revealed education level to be the most significant factor associated with health professionals' satisfaction on the scheme, such as satisfaction on payment level of non-maternal and child healthcare services (x2=7.734, df=2, p=.021), satisfaction on availability of drugs, and other medical consumables (x2=7.188, df=2, p=.027), and health workers availability (x2=6.971, df=2 p=.031). Then, results revealed experience as the factor associated with satisfaction on health workers availability (x2=6.971, df=2p=.027) and satisfaction on the working environment (x2=6.090, df=2, p=.048). Moreover, results revealed facility level to be the factor associated with health professionals' satisfaction on the increase of health services provided by the PBF scheme (x2=9.500, df=2, p=.009), profession to be the factor associated with satisfaction on availability of health workers (x2=7.204, df=4, p=.046). Conclusion: A study on the factors that influence PBF toward universal health coverage in Muramvya Province of Burundi. This study revealed a need for regular training on the PBF scheme among health workers. In addition, however, there is a need for the motivation of health workers to face a high level of brain drain in health workers in Burundi.