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General

Study Overview

Title:

Impact Evaluation of a Performance-based Financing Pilot in Cameroon

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-529635076cc92

Initial Registration Date:

11/27/2013

Last Update Date:

11/23/2013

Study Status:

Ongoing

Abstract:

The larger policy objectives are to (a) Identify the impact of Performance Based Financing (PBF)on maternal and child health (MCH) service coverage and quality, (b) Identify key factors responsible for this impact, and (c) Assess cost-effectiveness of PBF as a strategy to improve coverage and quality. The study will have a pre-post with comparison design. We will rely primarily on experimental control to answer the main research questions for this study. Individual health facilities in each region will be randomized to one of the 4 study groups. Individual public and private primary care health facilities in 14 districts from the 3 pilot regions will be randomly assigned to each study group. The evaluation will rely on two main sources of data to answer the impact evaluation research questions identified: 1. Household surveys: A household survey will be implemented at baseline (mid 2012), and at endline (mid 2014). 2. Facility-based surveys: A facility-based survey will be implemented at baseline and at endline.

Registration Citation:

De Walque, D. and Robyn, PJ., 2013. Impact Evaluation of a Performance-based Financing Pilot in Cameroon. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie014

Categories:

Health, Nutrition, and Population

Additional Keywords:

Health care financing, provider payment, Performance Based Financing, Cameroon

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Damien de Walque

Affiliation:

The World Bank

Name of Second PI:

Paul Jacob Robyn

Affiliation:

The World Bank

Study Sponsor

Name:

The World Bank (Health Results Innovation Trust Fund)

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

L'Institut de formation et de recherche demographiques (IFORD)

Type of Organization:

Research institute/University

Location:

Cameroon

Intervention

Intervention Overview

Intervention:

The program that will be evaluated will implement Performance Based Financing (PBF) in public, private and Faith Based Organization (FBO) facilities across 14 districts in the North-West, South-West and East regions of Cameroon. The objectives are to improve the utilization and quality of maternal and child health services. Performance contracts will be signed between a Performance Purchasing Agency (PPA) and public, private and non-profit private sector health facilities in each region. These performance contracts will govern results-based payments to facilities, and performance bonuses from facilities to their health workers. Priority service delivery indicators will be purchased at higher rates and facilities will be allowed to retain PBF funds for use at the operational level, giving facilities management autonomy on how to use these funds. In total there are approximately 244 health facilities in the four targeted regions. The expected beneficiaries are woman and children residing in the areas targeted by the intervention.

Theory of Change:

Multiple Treatment Arms Evaluated?

Yes

Implementing Agency

Name of Organization:

Project Implementation Unit, Ministry of Public Health, Cameroon

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:

The World Bank (IDA)

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

03/01/2012

End Date:

12/01/2014

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

The study will be a blocked-by-region cluster-randomized trial (CRT), having a pre-post with comparison design. We will rely primarily on experimental control to answer the main research questions for this study. Individual health facilities in each region will be randomized to one of the 4 study groups. Individual public, private and faith-based primary care health facilities in 14 districts from the 3 pilot regions will be randomly assigned to each study group to create a factorial study design. This process of random allocation seeks to ensure that the four study groups are comparable in terms of observed and unobserved characteristics that could affect treatment outcomes so that average differences in outcome can be causally attributed.

Outcomes (Endpoints):

The main targeted outcomes fall into two main groups: (a) Maternal and Child Health Service coverage indicators and (b) Quality of care indicators. Maternal and child health outcomes include, but are not limited to: Children aged 12-23 months who are fully immunized, Contraceptive Prevalence Rate (modern methods), Unmet need for family planning, Children under 3 years who have received Vitamin A, and Skilled birth attendance. Quality of care outcomes include, but are not limited to: Proportion of full complement of clinical staff present on the day of survey, At least one female clinical staff present on the day of survey, Proportion of health facilities with water for hand washing, soap and clean towel in patient examination area, Proportion of health facilities with basic clinical equipment, Number of essential drugs available on the day of the survey, Average health worker clinical knowledge score, Under-five examination quality score (based on IMCI protocols), ANC examination quality score (based on national ANC protocols), and average patient satisfaction scores.

Unit of Analysis:

Health facilities, health workers and households.

Hypotheses:

We hypothesize that it is link between payments and results and not increased supervision and monitoring that is responsible for the improvements in maternal and child health service coverage and quality. In addition, the hypothesis to be tested is that enhanced supervision and monitoring in itself even in the absence of other interventions such as enhanced managerial autonomy, additional resources or performance-linked payments will result in improved MCH service coverage and quality.

Unit of Intervention or Assignment:

Primary health care facility

Number of Clusters in Sample:

244 in the 14 health districts included in the impact evaluation

Number of Individuals in Sample:

Health facilities: 244, Households: 3904 (2 stage sampling with 16 households per cluster)

Size of Treatment, Control, or Comparison Subsamples:

Health facilities: 61, Households: 976

Supplementary Files

Analysis Plan:

Other Documents:

Data

Outcomes Data

Description:

The evaluation will rely on two main sources of data to answer the impact evaluation research questions identified: 1. Household surveys: A household survey will be implemented at baseline and at endline (after 2 years) 2. Facility-based surveys: A facility-based survey will be implemented at baseline and at endline. The impact evaluation will use the HRITF survey instruments as a starting point and tailor them to the Cameroonian context.

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

Unit of Analysis:

Clusters in Final Sample:

Total Observations in Final Sample:

Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:

Preliminary Report URL:

Summary of Findings:

Paper:

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Survey Instrument Links or Contact:

Program Files:

Program Files Links or Contact:

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: