Pan African Journal of Political Science and Governance (Governance focus in | 27 December 2017
A Case Study in Kinshasa: Correlating Performance-Based Financing Structures with Maternal Immunisation Coverage in Masina Municipality, 2017
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Abstract
Performance-based financing (PBF) is a common health system reform in sub-Saharan Africa. Its operation and effects within fragile urban settings, specifically regarding maternal health services, remain underexplored. This case study investigates a PBF scheme for primary health clinics in an urban municipality. The study aimed to analyse the correlation between specific PBF incentive structures and maternal immunisation coverage rates. Its objective was to identify which contractual and payment mechanisms showed the strongest association with reported service delivery for antenatal tetanus immunisation. A qualitative case study methodology was employed. This involved document analysis of PBF contracts and payment verification reports from participating clinics. The analysis was supplemented by semi-structured interviews with health facility managers and municipal health officials administering the scheme. Analysis indicated a positive correlation between clearly defined payment indicators for immunisation and reported coverage rates. Clinics with contracts featuring simplified, verifiable immunisation targets demonstrated higher reported coverage. A critical finding was the importance of timely and predictable disbursement of PBF funds for maintaining clinic engagement. The study suggests that PBF structures characterised by transparent performance indicators and reliable payment flows can be correlated with improved maternal immunisation coverage in an urban African setting. The scheme’s effectiveness, however, was dependent on competent administrative oversight. PBF programmes in comparable urban contexts should prioritise unambiguous performance indicators for maternal health services. It is also essential to strengthen the financial management capacity of local health authorities to ensure prompt reimbursement. Further research should investigate patient-level health outcomes. performance-based financing, maternal health, immunisation, health systems, governance, Democratic Republic of Congo, urban health This case study provides empirical insight into the operational nexus between PBF design and reported service coverage in a fragile urban setting, contributing to governance-focused debates on health financing mechanisms in Africa.