Assessing the Impact of Performance-Based Financing on Maternal Health Service Quality in Burkina Faso: A District-Level Analysis

Performance-based financing (PBF) has been introduced in several sub-Saharan African countries to improve health service delivery. In Burkina Faso, a PBF scheme was implemented in selected health districts. Evidence of its specific effect on the quality of maternal health services at district level is limited. This study assessed the impact of the PBF scheme on key quality indicators for maternal health services in Burkina Faso. The primary objective was to compare changes in structural, process, and outcome quality measures between PBF-supported and non-PBF districts. A quasi-experimental design with a control group was employed. Data were collected from a representative sample of primary healthcare facilities across multiple health districts. Quantitative data from health facility assessments and routine health information systems were analysed using difference-in-differences regression models. Facilities in PBF-supported districts demonstrated a statistically significant improvement in several process quality indicators compared to control districts. The proportion of facilities with complete partograph use during labour increased by 22 percentage points more in PBF districts. Structural readiness for emergency obstetric care also showed greater improvement, though gains in final maternal health outcomes were less pronounced. The PBF scheme was associated with measurable improvements in the process and structural quality of maternal health services at district level. Financial incentives can influence provider adherence to clinical guidelines and facility preparedness. PBF programme design should strengthen linkages between process quality improvements and final health outcomes. Further integration of quality-of-care metrics into performance contracts is recommended. Sustainable domestic financing mechanisms for PBF should be explored. performance-based financing, maternal health, quality of care, health systems, Burkina Faso This study provides district-level evidence on the effect of performance-based financing on maternal health service quality in Burkina Faso, informing policy on health financing and quality improvement.