Effect of Performance-Based Financing on the quality of Obstetric Service delivery in Nkambe Health District, North Region, Cameroon

Abstract

Abstract Background Performance-based financing (PBF) aims to improve healthcare quality by offering financial incentives to service providers. This study evaluated PBF’s impact on obstetric care quality in Nkambe Health District, Cameroon. Methods We employed a cross-sectional mixed-methods study from December 2016–July 2017 in PBF-implementing facilities. We surveyed 315 women attending prenatal and postnatal visits and 23 service providers using structured questionnaires. Quantitative data were analyzed with SPSS v20, and quality was assessed via WHO standards. Results 99.7% of women attended ≥5 antenatal visits; 93% delivered institutionally; 93% had postnatal care. Partogram use was 88%; 96% women reported satisfaction. Providers’ knowledge was high (97% for ANC/intrapartum care). Schooling (p<0.05), ≥4 ANC visits (p=0.017), and proximity predicted quality. Providers (71%) were satisfied with pay. Conclusions PBF significantly enhanced obstetric care utilization and quality. Scale-up recommended with attention to costs, staffing, and attitudes.