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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Examining multiple funding flows to public healthcare providers in low-and middle-income countries-results from case studies in Burkina Faso, Kenya, Morocco, Nigeria, Tunisia and Vietnam
Health Policy and Planning, Volume 38, No. 10, Year 2023
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Description
Provider payment methods are traditionally examined by appraising the incentive signals inherent in individual payment mechanisms. However, mixed payment arrangements, which result in multiple funding flows from purchasers to providers, could be better understood by applying a systems approach that assesses the combined effects of multiple payment streams on healthcare providers. Guided by the framework developed by Barasa et al. (2021) (Barasa E, Mathauer I, Kabia E et al. 2021. How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them. Health Policy and Planning 36: 861-8.), this paper synthesizes the findings from six country case studies that examined multiple funding flows and describes the potential effect of multiple payment streams on healthcare provider behaviour in low-and middle-income countries. The qualitative findings from this study reveal the extent of undesirable provider behaviour occurring due to the receipt of multiple funding flows and explain how certain characteristics of funding flows can drive the occurrence of undesirable behaviours. Service and resource shifting occurred in most of the study countries; however, the occurrence of cost shifting was less evident. The perceived adequacy of payment rates was found to be the strongest driver of provider behaviour in the countries examined. The study results indicate that undesirable provider behaviours can have negative impacts on efficiency, equity and quality in healthcare service provision. Further empirical studies are required to add to the evidence on this link. In addition, future research could explore how governance arrangements can be used to coordinate multiple funding flows, mitigate unfavourable consequences and identify issues associated with the implementation of relevant governance measures. © 2023 World Health Organization,.
Authors & Co-Authors
Dkhimi, Fahdi
Switzerland, Geneva
Organisation Mondiale de la Santé
Honda, Ayako
Japan, Kunitachi
Hitotsubashi University
Hanson, Kara G.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Mbau, Rahab
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Onwujekwe, Obinna E.
Nigeria, Naukka
University of Nigeria
Phuong, Hoang Thi A.
Viet Nam, Hanoi
Ministry of Health Vitenam
Mathauer, Inke
Switzerland, Geneva
Organisation Mondiale de la Santé
Akhnif, El Houcine
Switzerland, Geneva
Organisation Mondiale de la Santé
Kiendrébéogo, Joel Arthur
Burkina Faso, Ouagadougou
Université Joseph Ki-zerbo
Ezumah, Nkoli N.
Nigeria, Naukka
University of Nigeria
Kabia, Evelyn
Kenya, Nairobi
Wellcome Trust Research Laboratories Nairobi
Barasa, Edwine W.
United Kingdom, Oxford
University of Oxford
Statistics
Authors: 12
Affiliations: 9
Identifiers
Doi:
10.1093/heapol/czad072
ISSN:
02681080
Research Areas
Health System And Policy
Study Approach
Qualitative
Study Locations
Burkina Faso
Kenya
Morocco
Nigeria
Tunisia