Access to high‐quality family planning services remains limited in many low‐ and middle‐income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance‐based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty‐eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow‐up data collection took place in 2021–2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand‐side interventions are likely needed in a setting with very low baseline utilization.

中文翻译：

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基于绩效的融资对刚果民主共和国计划生育服务的可用性、质量和使用的影响：影响评估

在许多低收入和中等收入国家，获得高质量计划生育服务的机会仍然有限，导致意外怀孕和不良健康后果的沉重负担。我们使用刚果民主共和国一项大型随机对照试验的数据来测试基于绩效的融资 (PBF) 是否可以提高计划生育服务的可用性、质量和使用。从 2016 年底开始，30 个卫生区被随机分配到 PBF 计划，其中卫生机构根据所提供服务的数量和质量获得融资。二十八个卫生区被分配到对照组，其中卫生设施获得了类似规模的无条件融资。后续数据收集发生在 2021 年至 2022 年期间，包括 346 项医疗机构评估、476 项计划生育咨询的直接临床观察以及 9,585 项家庭调查。多变量回归模型的结果表明，PBF 计划对计划生育服务的可用性和质量产生了强烈的积极影响。具体而言，该计划将医疗机构提供计划生育服务的可能性提高了 20 个百分点，并将医疗机构提供避孕药、注射剂和埋植剂的可能性分别提高了 23 个百分点、24 个百分点和 20 个百分点。该项目还将计划生育咨询的流程质量提高了0.59个标准差。尽管取得了这些进步，并且除了服务费的减少外，该计划对避孕药具的使用产生了一定的影响，使性活跃的育龄妇女的现代避孕方法的使用增加了 4 个百分点（相当于增加了 37%），并且没有对青少年避孕措施的使用产生重大影响。这些结果表明，尽管 PBF 可以成为改善计划生育服务供应的有效方法，但在基线利用率非常低的环境中，可能需要补充需求方干预措施。