Appraising the Effects of Performance-Based Financing on Healthcare Service Utilization in Nasarawa State, Nigeria

Background: Performance-based financing (PBF) is an innovative approach that can potentially optimize the demand for facility-based care and services. This study aimed to appraise the effects of PBF on healthcare services utilization in Nasarawa State, Nigeria. Methods: The study employed a cross-sectional design at three randomly selected PBF-benefiting Primary Healthcare Centres (PHCs). Using mixed methods, structured checklists and key informant interviews (KIIs) were utilized for data collection across three PBF program periods: at the beginning (2013), at the end (2020) and two years post-intervention. Facility attendance was examined using a Poisson Regression Model at p<0.05 level of statistical significance. Results: Data from 25,025 facility users were analysed; most were females (72.0%), and aged 1-25 years (58.3%). Services utilized included out-patient care (33.3%), antenatal care (24.5%), postnatal care (15.4%). Facility attendance is statistically significant at the end of PBF intervention (Poisson regression coefficient [µ]= 1.2403, p=0.000) and two years post-intervention (µ=1.4564, p=0.000). The KII participants attributed the change to enhanced resources from the PBF project and reported that facilities are experiencing resource shortages and infrastructure issues that ultimately impact patient flow and service utilization; thus, they proposed the provision of additional human and material resources to address the challenges. Conclusion: The study finds evidence for the positive effects of PBF on healthcare service utilization intra-intervention but not two years post- intervention. Future research is needed to determine the mechanisms for sustaining PBF intervention gains and explore factors contributing to the decline in service utilization post-intervention.