Healthy competition drives success in results-based aid: Lessons from the Salud Mesoamérica Initiative

<div><p>Objectives</p><p>The Salud Mesoamérica Initiative (SMI) is a three-operation strategy, and is a pioneer in the world of results-based aid (RBA) in terms of the success it has achieved in improving health system inputs following its initial operation. This success in meeting pre-defined targets is rare in the world of financial assistance for health. We investigated the influential aspects of SMI that could have contributed to its effectiveness in improving health systems, with the aim of providing international donors, bilateral organizations, philanthropies, and recipient countries with new perspectives that can help increase the effectiveness of future assistance for health, specifically in the arena of RBA.</p><p>Methods</p><p>Qualitative methods based on the criteria of relevance and effectiveness proposed by the Development Assistance Committee of the Organization for Economic Co-operation and Development. Our methods included document review, key informant interviews, a focus group discussion, and a partnership analysis.</p><p>Participants</p><p>A purposive sample of 113 key informants, comprising donors, representatives from the Inter-American Development Bank, ministries of health, technical assistance organizations, evaluation organizations, and health care providers.</p><p>Results</p><p>During May–October 2016, we interviewed regarding the relevance and effectiveness of SMI. Themes emerged relative to the topics we investigated, and covered the design and the drivers of success of the initiative. The success is due to 1) the initiative’s regional approach, which pressured recipient countries to compete toward meeting targets, 2) a robust and flexible design that incorporated the richness of input from stakeholders at all levels, 3) the design-embedded evaluation component that created a culture of accountability among recipient countries, and 4) the reflective knowledge environment that created a culture of evidence-based decision-making.</p><p>Conclusions</p><p>A regional approach involving all appropriate stakeholders, and based on knowledge sharing and embedded evaluation can help ensure the effectiveness of future results-based aid programs for health in global settings.</p></div

Timeline of Salud Mesoamerica Initiative’s operations and respective indicators’ measurements.

<p>^a: baseline measurements were conducted in 2011 only in El Salvador. ^b: on average operations are 24 months but do not start at the same time in all countries and hence might appear longer. ^c: dates for the 3rd operation and its respective indicators’ measurements are not final at this time.</p

Key informants of the Salud Mesoamerica Initiative process evaluation.

<p>Key informants of the Salud Mesoamerica Initiative process evaluation.</p

Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews

<div><p>There is a paucity in current literature about the level of patients’ satisfaction and factors influencing it in Bangladesh health system. We aimed to measure the level of patients’ satisfaction across different types and levels of healthcare facilities and to determine which factors influence this satisfaction level. A patient exit interview was carried out among 2207 patients attending selected health facilities in two administrative divisions of Bangladesh, namely Rajshahi and Sylhet. Information on healthcare experience and satisfaction with received care was collected through an electronic structured questionnaire. Information about <i>‘overall satisfaction with healthcare’</i> was collected on a 10-point scale and then dichotomized based on the median-split. Binomial logistic regressions, both simple and multivariable, were conducted to identify which factors contribute significantly to patients’ satisfaction. We found that 63.2% of the participants were satisfied with the healthcare service they received. Patients attending the private facilities had the highest level of satisfaction (i.e. 73%) and patients attending the primary care facilities had the lowest level of satisfaction (i.e. 52%). Factors like convenient opening hours, asking related questions to the providers, facility cleanliness and privacy settings were significantly associated with patients’ satisfaction. Being satisfied with facility cleanliness (multivariable OR 4.30; 95% CI: 3.29–5.62) and privacy settings (multivariable OR 1.68; 95% CI: 1.28–2.21) were the strongest predictors of patients’ satisfaction. In conclusion, a significant portion of the patients in Bangladesh are not satisfied with their received care. Patients’ satisfaction can be increased by focusing on improving facility cleanliness, privacy settings and providers’ interpersonal skills.</p></div

Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews - Fig 1

<p><b>Levels of patients’ satisfaction (%) with 95% confidence intervals according to (A) healthcare facility types and (B) healthcare facility levels.</b> Public facilities included community clinics, Union Health and Family Welfare Center (UHFWC), Union Sub-center (USC), Upazilla Health Complex (UHC), Medical College hospitals, District Sadar/General hospitals. Private facilities included private hospitals, private clinics, NGO clinics and pharmacies. Primary care facilities included Union Health and Family Welfare Center (UHFWC), Union Sub-center (USC) and Upazilla Health Complex (UHC). Higher care facilities included Medical College hospitals, District Sadar/General hospitals, private hospitals and private clinics.</p

Distribution of patients by facility type who participated in the patient exit survey.

<p>Distribution of patients by facility type who participated in the patient exit survey.</p

Patients’ healthcare experiences according to facility types, presented as percentages.

<p>Patients’ healthcare experiences according to facility types, presented as percentages.</p

Factors influencing patients’ satisfaction from logistic regression with odds ratio (OR) and 95% confidence intervals (CIs).

<p>Factors influencing patients’ satisfaction from logistic regression with odds ratio (OR) and 95% confidence intervals (CIs).</p

Patients’ healthcare experiences according to various levels of facilities, presented as percentages.

<p>Patients’ healthcare experiences according to various levels of facilities, presented as percentages.</p