Results Based Financing and Performance of Health Service Delivery in Oyam District: A Case of Selected Health Centers

Abstract

This study aimed to evaluate the contribution of Results-Based Financing (RBF) on the performance health service delivery in Oyam district, Uganda. Specifically, it sought to assess the effect of output-based aid on health service delivery in Oyam district, to assess the effect of conditional cash transfers on health service delivery in Oyam district and to investigate the effect of incentivization on transfers on health service delivery in Oyam district. The study was guided by the following research questions; what is the effect of output-based aid, Conditional Cash Transfers, and Incentivization on health service delivery in Oyam district? The study is expected to inform decision making and add to the body of knowledge on RBF and health service delivery. The study was guided by the expectancy and agency theories and it employed a cross-sectional study design, incorporating both quantitative and qualitative methodologies to comprehensively explore the contribution of RBF to health service delivery. The study had a population of 170 individuals and a sample size of 150 participants. Purposive and stratified random sampling techniques were used to categorize the study participants and the data collection tools included questionnaires and interview guide. After, data collection, all questionnaires were entered using SPSS 23 software. Descriptive statistics were then computed to summarize variables. Finally, correlation and regression analyses were performed to determine relationships between variables, with all significant variables tested at a 5% level of significance. Output Based Aid and Conditional Cash Transfers showed no significant effect on health service delivery (B-0.011, p-0.921 and B-0.147, p-0.139 respectively), while Incentivization had a significant positive effect on health service delivery (B-0.150, p=0.007). The Adjusted R-squared value of 0.117 suggested that approximately 11.7% of the variance in health service delivery was explained by the predictors, implying the influence of other unaccounted factors. In other words, among the studied RBF components, only incentivization significantly enhances health service delivery. However, other unexplored factors contribute to health service delivery variations, suggesting the need for comprehensive research to address broader influences. Therefore, this study recommends that Oyam district local government should effectively communicate the benefits of Output Based Aid (OBA) to health providers for better program adherence, Ministry of Health (MOH) should enhance monitoring of Conditional Cash Transfers (CCTs) to ensure proper fund utilization and health outcome achievement, health managers must foster ethical behavior and accountability among staff and oversight mechanisms to align incentives with health goals and prevent resource misuse, thereby improving overall health service delivery.