Background
Defining quality of healthcare: definition and measures
Methods
Protocol and registration
Selection of studies
Inclusion criteria
Exclusion criteria
Type of studies
Types of participants
Type of interventions
Operational definitions
Outcomes of interest
Information sources and search
Thematic Search
| |
“provider performance” OR “provider incentives” OR “pay for performance” OR “performance-based financing” OR “performance-based incentives” OR “supply-side incentive” OR “provider performance” OR “results-based financing” | |
AND | |
“quality of care” OR “clinical standards” OR “structural quality” OR “process quality” | |
AND | |
“Maternal health/” [MeSH] OR “ante natal/pre natal” OR “post natal/postpartum” OR “child birth/delivery/institutionalized” OR “newborn/neonatal” OR “immunization/vaccination” OR “children/child” OR “nutrition/stunting/anemia” | |
Adjunct Search
| |
“Developing countries/less developed nations/third world countries”[MeSH] OR “developing health Systems” [MeSH] OR Africa/sub-Saharan africa” [MeSH] “Central/south/latin america”[MeSH] OR “asia/central/south east Asia”[MeSH] OR “commonwealth of independent states”[MeSH] OR “indian ocean islands”[MeSH] OR “eastern europe”[MeSH] OR “south asia” OR “low income countries/low and middle income Countries” |
Data items and extraction
Summary measures and data synthesis
Appraising methodological and reporting quality of included studies
Results
Study selection
Study characteristics and settings
Author, year; Country | Study Design | Program setting | Incentives | Comparison Group | Outcome measures | Quality element | Methodological Quality score (%) | ||
---|---|---|---|---|---|---|---|---|---|
Recipient | Conditionality | Frequency | |||||||
Peabody et al., 2011; Philippines [28] | CRT | 30 District hospitals (DH) | Providers | Physician competence score, case load and patient satisfaction | Quarterly | DHs from matched districts without P4P | Quality of care, utilization of services of children under-five | Process quality | 13(72) |
Peabody et al., 2014; Philippines [29] | CRT | 30 District hospitals | Providers | Physician competence score, case load and patient satisfaction | Quarterly | DHs from matched districts without P4P | Quality of care, utilization of services of children under-five | Clinical outcomes for under-five children | 14(78) |
Huillery and Seban 2014; DRC [30] | CRT | 152 Facilities (primary and secondary level) | Facilities | Utilization of services | Monthly | Facilities in control districts receiving equivalent fixed payment | User fees, service accessibility, service quality and utilization, population health status, health facility revenue, health workers’ satisfaction, anxiety, motivation | Patient perceived quality and structural quality | 14(78) |
Basinga et al., 2011; Rwanda [27] | Controlled before and after | Rural health centers - 80 in intervention and 86 in control | Facilities | Utilization of 14 key MCH services and quality of services delivery | Quarterly | Facilities under input-based financing received funds equivalent to P4P payments | Prenatal visits, institutional delivery, quality of ANC, child preventive care visits and immunization | Process quality of ANC | 15(88) |
Bonfrer et al., 2014; Burundi [25] | Controlled before and after | 700 facilities | Facilities | Obtaining quality and quantity of services | Monthly for quantity and quarterly for quality | Households in the provinces where P4P was not implemented | Utilization and quality of MCH services | Process quality of ANC | 10(59) |
Bonfrer et al., 2014; Burundi [26] | Controlled before and after | 700 facilities | Facilities | Obtaining quality and quantity of services | Monthly for quantity and quarterly for quality | Facilities in control districts receiving normal input financing and salary bonus | Maternal and under-five services | Structural and process quality | 9(53) |
Soeters et al 2011; DRC [24] | Controlled before and after | Two districts | Facilities | Utilization of services | Monthly for quantity and quarterly for quality | Two control districts with characteristics similar to intervention districts receiving essential drugs, equipment and fixed staff performance bonuses | Not mentioned | Patient perceived quality, structural and process quality | 7(41) |
Huntington et al., 2010; Egypt [31] | Case control post-test only | Primary health centers | Providers | Quantity and quality of preventive, curative and quality of MCH services | Monthly | Primary care providers in control arms got flat rate salary supplements | Quality of ANC, child care services and family planning care | Process quality of ANC, family planning and child care | 7(41) |
Characteristics of performance measures and payments on quality of care
Reporting of quality of care in studies
Risk of bias across studies
Effects of interventions
Structural quality
Variable | Net treatment effect |
P value |
---|---|---|
Qualified staff in facilitiesa
| 15 | <0.05 |
Sufficient drug availability (patient perceived)b
| 0.04 | 0.492 |
Provider clinical knowledge on child health (Mean Vignette score)c
| 1.6 | <0.001 |
Patient perceived availability of drugs (%)a
| 37 | <0.001 |
Patient perceived equipment qualityd
| 0 | 0.997 |
Structural quality index based on interviewers’ observationd
| −0.525 | 0.014 |
Infrastructure indexd
| 0.184 | 0.372 |
Equipment indexd
| −0.639 | 0.026 |
Number of types of vaccine currently availabled
| −0.744 | 0.034 |
Number of types of drug currently availabled
| 0.236 | 0.646 |
Process quality
Variable | Net treatment effect |
P value |
---|---|---|
History taking | ||
Asked name during ANC visita
| 4.3 | NS |
Asked age during ANC visita
| 4.5 | NS |
Asked parity during ANC visita
| 11.4 | <0.01 |
Asked date of last menses during ANC visita
| 2.9 | NS |
Asked past illnesses during ANC visita
| 16.4 | <0.01 |
Examination | ||
Examined weight during ANC visita
| 5.8 | NS |
Examined blood pressure during ANC visita
| 8.4 | <0.01 |
Examined fetal heart rate during ANC visita
| 10.9 | NS |
Prescription and Treatment | ||
Asked for blood test during ANC visita
| 12 | <0.01 |
Asked for urine analysis during ANC visita
| 20 | <0.01 |
Explained intake of tetanus toxoid during ANC visita
| −8.4 | NS |
Explained intake of Vitamins during ANC visita
| 5 | NS |
Explained medicine intake for under-five (%)a
| 11.1 |
p < 0.05 |
Overall treatment procedures (patient perceived) during ANC visita
| −5.5 | NS |
Drugs prescribed to pregnant women without examinationb
| 0.02 | 0.66 |
Children received injection (%)a
| −6 |
p < 0.05 |
Children received follow up (%)a
| 2.4 |
p < 0.05 |
Children given medicine (%)a
| 24.2 |
p < 0.05 |
Overall process quality | ||
Compliance rate with medical procedure, any serviceb
| −0.015 | 0.695 |
ANC process quality scorec
| 0.157 | <0.001 |
Quality outcomes
Variable | Net treatment effect |
P value |
---|---|---|
Patient knowledge | ||
Women knew medicine-use in prenatal perioda
| 12 | <0.05 |
Women knew medicine-use in prenatal periodb
| −0.072 | 0.039 |
Health outcomes | ||
CRP negative for under-fivec
| 0.84 | 0.497 |
Not anemic under-fivec
| −4.87 | 0.253 |
Good GSRH for under-fivec
| 7.37 | 0.001 |
Weight-for-height z-score of under-fiveb
| −0.347 | 0.306 |
Number of under-five deaths last year in householdsb
| 12 | 0.55 |
Out-of-pocket expenses | ||
Fee paid for the deliveryb
| 301.24 | 0.762 |
Fee paid for the last postnatal visitb
| −71.637 | 0.35 |
Fee paid for the last prenatal visitb
| −112.969 | 0.125 |
Fee paid for the last immunization shotb
| −22.096 | 0.237 |
Cost of drugs purchased by the patient at facilitiesb
| −1106.16 | 0.005 |
Client Satisfaction | ||
Felt cured (pp)d
| 11 | NS |
Acceptable waiting time (pp)d
| 7 | NS |
Respect by staff (pp)d
| 12 | <0.10 |
Felt cured (coefficient)e
| 0.09 | 0.012 |
Waiting time reasonable (coefficient)e
| −0.12 | 0.318 |
Personnel respectful (coefficient)e
| −0.02 | 0.718 |
Adequate consultation time (minutes)b
| 1.028 | 0.422 |
Pregnant women satisfied on user feesb
| 0.012 | 0.48 |
Pregnant women satisfied on welcome qualityb
| −0.027 | 0.442 |
Pregnant women dissatisfied on user feesb
| 0 | 0 |
Pregnant women dissatisfied on welcome qualityb
| 0 | 0.946 |
Pregnant women satisfied on total care qualityb
| −0.005 | 0.671 |
Patient overall satisfiedb
| 0.013 | 0.359 |
Overall quality of care | ||
Overall patient perceived quality score on ANC (pp)d
| 25 | <0.05 |
Overall professional quality score of health centers (pp)d
| 26 | <0.001 |
Total facility quality score (coefficient)e
| 17.24 | 0.062 |
Patient perceived quality of care (coefficient)e
| 0 | 0.924 |