Effects of results-based financing of maternal and child health services on patient satisfaction in Afghanistan.

Objective: To examine the impact of a results-based financing programme on patient satisfaction in Afghanistan.

Methods: We analysed data collected from over 3000 patients from a stratified sample of 112 health facilities (56 results-based financing and 56 non-results-based financing) in 11 out of the 34 provinces of Afghanistan over a three-year period. The 112 facilities were part of 442 primary care facilities that were stratified on facility type and randomly assigned to the results-based financing (intervention) and non-results-based financing (control) groups in the 11 provinces. Data were obtained from the National Health Service Performance Assessment, a baseline survey of patients conducted in 2010, and two follow-up surveys in 2011 and 2012. Measurement of patient satisfaction used a questionnaire comprising 11 questions concerning overall satisfaction, and satisfaction with specific aspects of care, from provider behaviour (e.g. respectfulness, communication) to cleanliness, opening hours and waiting times of facilities. We used a regression adjusted difference-in-differences estimator to investigate the treatment effect on patient satisfaction at facility level.

Results: There were some improvements in patient satisfaction in results-based financing facilities but these were not statistically significant. In 2011, 2 out of 11 aspects of satisfaction showed 5% improvement: satisfaction with the way health care providers explained the patient's condition and treatment. In 2012, patient satisfaction was higher for almost all aspects of care in results-based financing facilities, including the two aspects on health care provider respectfulness and facility opening hours, which had been 5% lower in results-based financing facilities than in non-results-based financing facilities in 2011. Overall satisfaction was almost 10% higher in results-based financing facilities than in non-results-based financing facilities in 2012.

Conclusion: Even if not statistically significant, observed trends suggest some positive impacts of the results-based financing programme on patient satisfaction.