Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial

Günther Fink, György Fritsche, Hadia Samaha, Claude Sese, Gil Shapira, Günther Fink, György Fritsche, Hadia Samaha, Claude Sese, Gil Shapira

Abstract

Background: Despite increasing access to health care, under-5 mortality remains high in many parts of Sub-Saharan Africa. Interventions to improve quality of care have mostly focused on additional training for medical staff, but generally shown little impact. We will assess the impact of financially incentivized quarterly provider knowledge assessment on compliance with Integrated Management of Childhood Illness (IMCI) protocols in Congo, DRC.

Methods: Out of a total of 1738 facilities currently receiving results-based financing under an ongoing health financing program, 110 facilities were chosen for this study. All health care workers providing outpatient services to children under age 5 in these facilities will be included in the study. Facilities were randomized with equal probability to control and treatment. Treatment facilities will receive quarterly medical staff knowledge assessments using interactive vignettes. Performance on these vignettes will be rewarded through financial bonus payments to facilities. A baseline survey of health worker knowledge was conducted in 2018. An endline assessment is scheduled to start in the second half of 2021. The primary outcome of interest is health worker compliance with Integrated Management of Childhood Illness (IMCI) guidelines. Compliance will be verified through direct observation of medical staff-patient interactions.

Discussion: This is to our knowledge the first trial assessing whether linking health financing to health care worker performance on knowledge assessments can increase compliance with under-5 case management protocols.

Trial registration: ClinicalTrials.gov NCT04634019 . Registered on November 18, 2020.

Keywords: Financial incentives; Health care worker knowledge; IMCI; Quality of care; Under-5 mortality; Vignettes.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Incentive structure
Fig. 2
Fig. 2
SPIRIT overview over study activities

References

    1. UN Inter-agency Group for Child Mortality. Levels & trends in child mortality. Geneva: UNICEF; 2017. .
    1. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Gerland P, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275–2286. doi: 10.1016/S0140-6736(15)00120-8.
    1. de Savigny D, Mayombana C, Mwageni E, Masanja H, Minhaj A, Mkilindi Y, et al. Care-seeking patterns for fatal malaria in Tanzania. Malar J. 2004;3:27. doi: 10.1186/1475-2875-3-27.
    1. Kallander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86(5):332–338. doi: 10.2471/BLT.07.049353.
    1. Willcox ML, Kumbakumba E, Diallo D, Mubangizi V, Kirabira P, Nakaggwa F, et al. Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry. Lancet Global Health. 2018;6(6):e691–e702. doi: 10.1016/S2214-109X(18)30215-8.
    1. Fink G, Ross R, Hill K. Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys. Int J Epidemiol. 2015;44(6):1879–1888. doi: 10.1093/ije/dyv115.
    1. Leslie HH, Fink G, Nsona H, Kruk ME. Obstetric facility quality and newborn mortality in Malawi: a cross-sectional study. PLoS Med. 2016;13(10):e1002151. doi: 10.1371/journal.pmed.1002151.
    1. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Global Health. 2018;6(11):e1196–e1252. doi: 10.1016/S2214-109X(18)30386-3.
    1. Leslie HH, Gage A, Nsona H, Hirschhorn LR, Kruk ME. Training and supervision did not meaningfully improve quality of care for pregnant women or sick children in Sub-Saharan Africa. Health Aff (Project Hope). 2016;35(9):1716–1724. doi: 10.1377/hlthaff.2016.0261.
    1. Das A, Gopalan SS, Chandramohan D. Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review. BMC Public Health. 2016;16:321. doi: 10.1186/s12889-016-2982-4.
    1. Rowe AK, Rowe SY, Peters DH, Holloway KA, Chalker J, Ross-Degnan D. Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review. Lancet Global health. 2018;6(11):e1163–e1175. doi: 10.1016/S2214-109X(18)30398-X.
    1. WHO. WHO country profile. 2019. .
    1. Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité (MPSMRM) Ministère de la Santé Publique (MSP), International I. Enquête Démographique et de Santé en République Démocratique du Congo 2013-2014. Rockville: MPSMRM, MSP et ICF International; 2014.
    1. Clarke-Deelder E, Shapira G, Samaha H, Fritsche GB, Fink G. Quality of care for children with severe disease in the Democratic Republic of the Congo. BMC Public Health. 2019;19(1):1608. doi: 10.1186/s12889-019-7853-3.
    1. Perales NA, Wei D, Khadka A, Leslie HH, Hamadou S, Yama GC, et al. Quality of clinical assessment and child mortality: a three-country cross-sectional study. Health Policy Plan. 2020;35(7):878–887. doi: 10.1093/heapol/czaa048.

Source: PubMed

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