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Study Overview

Impact evaluation for Performance-Based Financing for Health in Burkina Faso
Study is 3ie funded:
Study ID:
Initial Registration Date:
Last Update Date:
Study Status:
Burkina Faso
The overall objective of the impact evaluation is to scientifically evaluate the impact of the Performance Based Financing (PBF) intervention on maternal and child health outcomes in Burkina Faso, such as quality of care and health service utilization. The impact evaluation has a specific focus on the role of PBF, in combination with various demand-side interventions, in improving equity in health outcomes across socio-economic groups. The primary research questions for the impact evaluation will be: • Does performance-based financing increase utilization and quality of maternal and child health services delivered in Burkina Faso? • Does PBF improve financial access to and utilization of quality health services for vulnerable populations without systematic targeting of the poor? • Does PBF improve financial access to and utilization of quality health services for vulnerable populations through systematic targeting of the poor for improved health service coverage among vulnerable populations? • Does the combination of PBF and community-based health insurance generate added value to improve access to and quality of health services for all populations?
Registration Citation:
Health, Nutrition, and Population
Additional Keywords:
Health financing, PBF, equity, social protection, maternal and child health, targeting of the poor, health insurance
Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:
Paul Robyn
The World Bank
Name of Second PI:
Aurelia Souares
University of Heidelberg, Institute of Public Health

Study Sponsor

The World Bank
Study Sponsor Location:
United States

Research Partner

Name of Partner Institution:
University of Heidelberg, Institute of Public Health
Type of Organization:
Research institute/University

Intervention Overview

- Intervention 1: Traditional performance-based financing: PBF performance agreements concluded between the Ministry of Health and the health center will define the package of basic services to be provided, and the indicators and targets to be reached in delivering these services. The results achieved against these targets will then be assessed by external reviewers every three months. Based on these verified results, each facility under a PBF contract will receive payments in partial reimbursement for the services delivered. - Intervention 2: Traditional performance-based financing + systematic targeting and subsidization for the poor: Intervention 2 will use the institutional framework of Intervention 1 but will also include specific indicators linked to the provision of care for extremely vulnerable households in the health facility catchment areas. 2 levels of payment will be introduced. - Intervention 3: Traditional performance-based financing + community-based health insurance (including targeting of the poor): Intervention 4 will use the institutional framework of Intervention 2 but will be introduced in parallel to the extension of community-based health insurance.
Theory of Change:
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
Ministry of Health, Government of Burkina Faso
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:
The World Bank
Type of Organization:
Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?
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End Date:
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Difference in difference/fixed effects
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:
The study will adopt a blended experimental and quasi-experimental design, including both randomization of additional interventions at the facility-level with PBF districts (experimental) to test the effects of these interventions on outcomes of interest, conditional on PBF, and matching of facilities in neighboring pure control districts (quasi-experimental), to test the effects of these interventions, including PBF, in the absence of any intervention (counterfactual). Individual health facilities in each PBF intervention district in 4 regions (Centre Nord, Nord, Sud Ouest, Centre Est) will be randomized to one of 3 study groups (T1, T2 and T3). There will be approximately 100 health facilities in each of the intervention arms and 100 in the control group. In the 2 intervention districts of the Boucle du Mouhoun region, individual health facilities will be randomized to one of the 2 study groups (T1, T4). There will be 25 health facilities in each study group and 30 health facilities in the control group.
Outcomes (Endpoints):
% of women who have had 1 antenatal care visits in most recent pregnancy % of women who have had 4 or more antenatal care visits in most recent pregnancy % of women who received at least 1 dose of malaria intermittent preventive treatment % of women who received at least two tetanus toxoid vaccinations in most recent pregnancy % of women who had skilled birth attendance % of women who came for postnatal visit after most recent pregnancy % of women who knew at least one modern family planning method % of women reporting the use of modern contraceptive methods % of unmet need for Family Planning % of children under 1 year who are fully immunized % of children under 3 years who have received Vitamin A % of complicated malaria treated according to protocol % of childhood diseases screened according to the child health (IMCI) approach % of children aged between 11 and 59 months who have participated in growth monitoring in the previous month % of children aged under 6 months who are exclusively breastfed % of wasting and stunting among under 5 % of poor households covered by demand-side interventions Number of consultations by socio-economic status (SES) group
Unit of Analysis:
Households and health facilities
We have hypothesized that: 1. Purchasing priority quality-adjusted service outputs can incentivize facility managers and health workers to expand the delivery of priority and high quality maternal and child health (MCH) service outputs in a client-focused manner and to increase demand for health services; 2. Independent monitoring can also encourage managers to work for results while managerial autonomy and supervisory support can enable them to respond to these incentives; 3. Performance bonuses to health workers can incentivize health workers to adopt a client-friendly attitude, reduce absenteeism and reduce informal charges to patients. In addition to the abovementioned expected outcomes from the traditional supply-side PBF intervention, by introducing additional mechanisms within the PBF framework that aim to improve health service coverage across all socio-economic groups, including the most vulnerable, we hypothesize that: 4. Health workers and communities will be incentivized to ensure access to essential services for the poor; 5. Service delivery will become more efficient through risk pooling and cross-subsidization.
Unit of Intervention or Assignment:
Health facility catchment area
Number of Clusters in Sample:
400 health facilities
Number of Individuals in Sample:
7000 households
Size of Treatment, Control, or Comparison Subsamples:
Approximately 100 health facility catchment areas for T1, T2 and T3 in the Centre Nord, Nord, Sud Ouest, and Centre Est regions and 35 for T4 and T1 in the Boucle de Mouhoun region

Supplementary Files

Analysis Plan:
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Outcomes Data

Health facility and household surveys at baseline and endline.
Data Already Collected?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Treatment Assignment Data

Participation or Assignment Information:
Data Obtained by the Study Researchers?
Data Previously Used?
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Data Obtained by the Study Researchers?
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Data Analysis

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Study Materials

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Registration Category

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

Completion Overview

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Unit of Analysis:
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Preliminary Report:
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Data Availability

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Other Materials

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Description of Changes:

Study Stopped