Effect of results-based financing on selected maternal and child health indicators in Mayuge District, Uganda: a comparative interrupted time series analysis

Background Uganda continues to experience a high burden of maternal and child morbidity and mortality, partly due to suboptimal utilization and quality of reproductive, maternal, newborn, and child health services. To address these challenges, the Ministry of Health of Uganda, with World Bank funding, implemented results-based financing (RBF) through the Uganda Reproductive, Maternal, and Child Health Services Improvement Project (URMCHIP) in selected districts. Although RBF has been implemented for nearly a decade, evidence on its impact on maternal and child health service indicators in Uganda remains limited. This study assessed the effect of RBF on selected maternal and child health indicators in Mayuge District, Uganda. Methods We retrospectively reviewed the records between July 2018 and June 2019 as the pre-intervention period, July 2019 to June 2021 as the intervention period, and July 2021 to June 2023 as the post-intervention period. We conducted multiple-group interrupted time-series analyses to compare trends in selected maternal and child health indicators between four intervention and three non-intervention health facilities. Results After the implementation of RBF, the number of births in the intervention facilities increased by 1.67 births per month (95% CI [0.19, 3.16]) as compared to the control facilities. The number of women receiving modern family planning methods in intervention facilities increased by 34.1 women per month (CI [25.8, 42.4] as compared to the control facilities. The number of children under five years seen at the outpatient department slightly decreased by -0.24 children per month (CI [-9.58, 9.10]). There was a decline in facility-based births and the number of clients receiving modern family planning methods following the discontinuation of results-based financing in the intervention health facilities. Conclusions There was an improvement in selected maternal and child health indicators in the intervention health facilities following the implementation of RBF, with a subsequent decline in facility-based births and the number of clients receiving modern family planning methods after RBF was discontinued. We recommend that policymakers consider allocating additional funds towards RBF to improve health service delivery.