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. 2014 Dec 2;3(3):304. doi: 10.4081/jphr.2014.304

Table 1.

Conceptual framework: program theory explaining the causal pathways of the effectiveness of demand-side financial (DSF) programs through context-mechanism-outcome configuration (input + contextual elements + mechanisms = consumer effects of DSF initiatives).

Outcome Input factor of DSF scheme configured on causal pathway Mechanism
Improved health seeking behavior Design feature of programs - i.e. application and enforcement of conditionality directly affects behavior compliance/health seeking
  1. Current background characteristics of beneficiaries interact with consumer accountability and finally affect care seeking behavior

  2. Consumer cognitive assumptions, motivations, health awareness, and socio-cultural beliefs impact consumer accountability and trust on providers and thereby care seeking behavior

  3. Length of beneficiary exposure on DSF program is directly proportional to a positive care seeking behavior as it influences consumer accountability

  4. Service delivery status(i.e. availability of supplies and drugs) can mould consumer accountability and trust on providers and thereby care seeking behavior Effectiveness of knowledge dissemination under a DSF program (how appropriate, regular, timely, appealing, and effective) can impact consumer accountability and trust on providers towards a positive care seeking behavior

Improved health status-
  1. Current economic and educational status of beneficiaries affect consumer accountability towards an improved health status

  2. Service delivery status (availability and quality) can interact with consumer accountability and trust on providers and finally influence health status

  3. Provider incentives can enhance their accountability to reduce or prevent irrational prescriptions and thereby elevate health status of patients

Reduced out-of-pocket spending (OOPS) Design features of programs i.e. how health aspects were covered comprehensively under conditionality to minimize the scope of OOPS
  1. Consumer background characteristics (e.g. demographic, geographic, health awareness etc.) can interface with their accountability and trust on providers in terms of rational health seeking behavior and provider choices to reduce OOPS

  2. Provider incentives elevate provider accountability and this in a way can reduce informal payments and irrational prescriptions towards lesser OOPS

Mechanisms are denoted in italics.