缩小差距?津巴布韦孕产妇保健成果中基于结果的融资和与社会经济相关的不平等。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Marshall Makate, Nyasha Mahonye
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引用次数: 0

摘要

基于结果的融资(RBF)计划于 2011 年首次在津巴布韦实施,并逐步推广到其他地区,旨在通过提高医疗服务的利用率来解决孕产妇健康结果的差异问题。本研究利用该计划的交错推广作为准实验设计,评估其对特定孕产妇健康结果中与资产财富相关的不平等的影响。目的是确定 RBF 是否能有效减少这些差异并促进公平的医疗服务。我们采用扩展的双向固定效应(ETWFE)模型,利用 RBF 实施过程中的时间变化以及出生时间的个体差异进行识别。利用 1999 年至 2015 年期间收集的津巴布韦人口与健康调查的汇总横截面和全国代表性数据,我们的分析揭示了相对和绝对孕产妇健康不平等的显著减少,尤其是在产前护理、剖腹产和计划生育的频率和时间方面。具体而言,在至少完成四次或四次以上产前检查(-0.026,p < 0.01)、一胎产前检查(-0.033,p < 0.01)、剖腹产分娩(-0.028,p < 0.005)和计划生育(-0.033,p < 0.005)方面,农村预算框架计划与不平等现象的减少有关。此外,该计划还与产前护理质量的提高有关,产前护理质量指数(-0.040,p < 0.01)的提高就证明了这一点。在农村预算框架地区,这些效果在社会经济地位较低的群体中更为明显,这凸显了农村预算框架在促进医疗服务公平获取方面的潜力。我们的研究结果主张采取有针对性的政策干预措施,优先扩大服务不足地区关键孕产妇保健服务的可及性,并将注重公平的措施纳入 RBF 框架,以确保在津巴布韦和其他低收入国家提供包容性和有效的医疗保健服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Closing the gap? Results-based financing and socio-economic-related inequalities in maternal health outcomes in Zimbabwe.

The results-based financing (RBF) programme, first implemented in Zimbabwe in 2011 and gradually expanded to other districts, aimed to address disparities in maternal health outcomes by improving the utilization of health services. This study leverages the staggered rollout of the programme as a quasi-experimental design to assess its impact on asset wealth-related inequalities in selected maternal health outcomes. The objective is to determine whether RBF can effectively reduce these disparities and promote equitable healthcare access. We employ an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF implementation as well as individual-level variation in birth timing for identification. Utilizing pooled cross-sectional and nationally representative data from the Zimbabwe demographic and health surveys collected between 1999 and 2015, our analysis reveals significant reductions in relative and absolute maternal health inequalities, especially in the frequency and timing of prenatal care, delivery by caesarean section and family planning. Specifically, the RBF programme is associated with reductions in disparities for completing at least four or more prenatal care visits (-0.026, P < 0.01), first-trimester prenatal care (-0.033, P < 0.01), delivery by caesarean section (-0.028, P < 0.005) and family planning (-0.033, P < 0.005). Additionally, the programme is associated with improved prenatal care quality, as evidenced by progress on the prenatal care quality index (-0.040, P < 0.01). These effects are more pronounced among lower socio-economic groups in RBF districts, highlighting RBF's potential to promote equitable healthcare access. Our findings advocate for targeted policy interventions prioritizing expanding access to critical maternal health services in underserved areas and incorporating equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare delivery in Zimbabwe and other low-income countries.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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