Impact of a Pay for Performance Strategy in the Improvement of Infection Prevention and Control Practices in Healthcare Facilities in the Context of the 2018 Ebola Virus Disease Outbreak in Nord Kivu: a quasi-experimental study
Authors: Kabego Landry , Kourouma Mamadou , Ousman Kevin , Baller April , Milambo Jean-Paul , Kombe John , Houndjo Bienvenu , Boni Franck-Eric , Musafiri Castro , Mulembo Siya , Kalumuna Stéphanie , Tshongo Moise , Athanase John , Moke Nancy , Kumutima Clarisse , Nkita Justin , Ngoma Polydor , Azzouz Chedly , Okum Raphaël , Yao Michel , Chamla Dick , Gueye Abdou Salam , Fall Ibrahima Soce 
Published: July 2022

Background
Strategy to mitigate various Ebola virus disease (EVD) outbreaks are focusing on Infection Prevention and Control (IPC) capacity building, supportive supervision and IPC supply donation. This study was conducted to assess the impact of a Pay for Performance Strategy (PPS) in improving IPC performance in healthcare facilities (HCF) in context of the 2018–2019 Nord Kivu/ Democratic Republic of the Congo EVD outbreak.
Methods
A quasi-experimental study was conducted analysing the impact of a PPS on the IPC performance. Sixty-nine HCF were selected following the inclusion criteria upon informed consent from the facility manager and the National Department of Health. Initial and process assessment of IPC performance was conducted by integrating response teams using a validated IPC assessment tool for HCF. A bundle of interventions was then implemented in the different HCF including training of health workers, donation of IPC kits, supportive supervision during the implementation of IPC activities, and monetary reward. IPC practices in HCF were assessment every two weeks during the intervention period to measure the impact. The IPC assessment tool had 34 questions aggregated in 8 different thematic areas: triage and isolation capacity, IPC committee in HCF, hand hygiene, PPE, decontamination and sterilization, linen management, hospital environment and Waste management. Data were analysed using descriptive statistics and analytical approaches according to the assumptions. R software (version 4.0.3) was used for all the analyses and a p-value of 0.05 was considered as the threshold for statistically significant results.
Results
Among 69 HCF involved in this study, 48 were private facilities and 21 state facilities. The median baseline IPC score was 44% (IQR: 21–65%); this IPC median score reached respectively after 2, 4, 6 and 8 weeks 68% (IQR: 59–76%), 79% (71–84%), 76% (68–85%) and 79% (74–85%). The improvement of IPC score was statistically significative. Spearman’s rank-order correlation revealed the associated between proportion of trained HCW and IPC score performance after 8 weeks of interventions (rs = .280, p-value = 0.02).
Conclusion
Pay for Performance Strategy was proved effective in improving healthcare facilities capacity in infection prevention and control practice in context of 2018 EVD outbreak in Nord Kivu. However, the strategy for long-term sustainability of IPC needs further provision. More studies are warranted on the HCW and patients’ perceptions toward IPC program implementation in context of Nord Kivu Province.