EXECUTIVE
Our study consists of the assessment of the programme
«Performance purchase» on the improvement of health status of the
population in Goma Health Zone. The general objective of the study was to
assess the programme «Performance purchase» on the improvement of
health status of the population in Goma Health Zone. This is an evaluative and
cross-sectional study. It deals with a survey conducted among managers of
different health facilities in Goma Health Zone and among the beneficiary
population.
In order to attain the objective, 380 patients with chronic
diseases were surveyed and a structured interview was conducted among the key
informants. The report writing, tables drawing and data analysis were carried
out by using Microsoft Word, Microsoft Excel and SPSS respectively.
We used stratified random sampling technique and a structured
interview was conducted among the key informants.
We asked the following specific question:
- What contribution does the programme «Performance
purchase» have on the knowledge level of the health service providers in
Goma Health Zone?
- What is the satisfaction level of the beneficiary population
in Goma Health Zone?
To anticipate the answers to these questions, three hypotheses
were formulated:
- The programme «Performance purchase» would
positively contribute in enhancing the knowledge of the health service
providers about primary health care and alert regarding epidemiological
situation of Goma Health Zone.
- The programme «Performance purchase» would
positively contribute in service organisation such as autonomy among the peers
to reference and counter reference systems to health facilities support in drug
supply and to the health zone support in fuel and office supplies as well as
incentive to the staff memebers.
- The satisfaction level of the population in the Goma Health
Zone would be high in a way that subsidies granted to health facilities would
tremendously reduce health care costs and would have a positive impact on the
quality of health care provided to that beneficiary population. It would help
the most deprived people to have access to health care in Goma Health Zone.
In order to obtain the results of the study, the following
objectives were fixed:
- To assess the contribution of the programme
«Performance purchase» on the health providers' knowledge.
- To assess the contribution of the programme
«Performance purchase» on the services organisation.
- To appreciate the level of the population's satisfaction.
After data collection, analysis and the interpretation of our
outcomes, the following results were yielded:
- The demographic characteristics of the participants has
shown that 66. 7% of health providers are men and 33.3% are women; all of them
were married. For the education level, 77.8% have secondary education and
22.22% have university education. Their ages ranges between 22 and 54 years.
- Concerning the demographic characteristics of the
beneficiary population, the study have shown that 4.2 % of our respondents are
aged between 15 - 25 years, 3.7 % belong to the age group of 25 - 34 years,
30.8% are between 35 - 44 years old, 14.7% are aged between 55-64 years and
26.1% are 65 years old or beyond. Considering the education level, 6.3% of the
respondents have no education, 42.6% have primary education level; 39.9 % have
a secondary education level and 11.3% have university level.
- The contribution of the programme «Perform
Purchase» on the health providers' knowledge revealed that 66.7 % of them
were trained on primary health care and 33.3% on the epidemic management.
- The study has proven that the programme «Perform
Purchase» has positive contribution on services organisation in health
facilities.
In fact the managers confirmed that they receive some grant of
drug, fuel and office supplies; they have reported that there is a great change
in mortality and morbidity rates due to assisted delivery and supervision
plan.
- Regarding the population's satisfaction, the study shows
that 56.5 % of the respondents report that the quality of the health care was
good, 26.3% considers that the quality of health care was quite good and only
17.2 % said that the quality of health care was bad.
The study indicates that 62.9% of the interviewed people feel
healed after treatment; 74% think that the waiting queue was short, 71.9% think
that patients were nicely welcomed and only 1.8% think that patients were
poorly welcomed. When patients are questioned about the direct change observed
in the programme, 73.7 % of them think that health care costs have decreased,
4.6% think that services organisation has improved and 9.7 % testify that there
was grant of equipments.
Finally, the following recommendations were made in order to
make this study, concerning the assessment of the
programme «Performance purchase », useful:
- At the central level
o To elaborate a financial programme based on performance in a
context of a fragile country like ours at the national level.
o To decentralize contractual process at health province and
district levels with a representative of Performance purchase, able to buy
health services in a fragile environment.
- At the intermediary level
o To grant a total autonomy to health facilities;
o May subsidies be rather paid in cash than other forms;
o May public, confessional and private health facilities be
integrated and the government regulators be enhanced.
- At the peripheral level:
o May the community association for verification and
assessment of patients' satisfaction be set up
o To respect the indicators pre-set for the objectives
attainment in order to contribute to the improvement of health services in Goma
health zone.
- To the population of the Goma Health
Zone
o To take part in all the steps of the planning for a better
management and involvement in the health activities.
- To researchers who would like to join global
movement of performance based financing
o To tackle the question regarding the incentive to health
providers and other parameters that we did not treat in this piece of work.
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