BENIN HRBF Names of Team Members Cape Town, South Africa December - - PowerPoint PPT Presentation

Measur suring ing Result lts s and nd Evalu luating ating Impa pact: t:

Turn rnin ing g Promise ises s in into Evid idence ence

Cape Town, South Africa December 2009

BENIN HRBF

Human Development Network Development Impact Evaluation Initiative Spanish Impact Evaluation Fund Africa Region

Names of Team Members

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• 1. Background

 The context:

 A health system where inputs are roughly sufficient (at

least for geographical accessibility, health workers) and no major cultural obstacle are seen.

 As a result, rate of skilled deliveries is very high (80%)  But maternal and neonatal mortalities are decreasing

very slowly

 A major problem of quality of care

 RBF as a national policy to address the issue:

 A supply-side program  Focused on quality and utilization of care (incl equity)  Implemented in 8 health districts (out of 34 existing)  With a community component for monitoring

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• 2. Result chain

Activities Products Outcomes Long term

• utcomes
• RBF payments (for

staff bonuses, for purchasing drug and training)

• Training programs

in management and clincial skills

• Incentives for

retention of qualified staff in rural areas

• Decreasing

maternal and neonatal mortality

• Increasing

quality of maternal care

• Increasing

utilization of maternal care among the poorest

• Improving

staff motivation

• Improving

staff skills

• Improving

availability of drugs

• 3. Primary Research Questions

 Does RBF improve quality and utilization ?  Does it improve motivation of health

workers ?

 Through peer pressure and/or supervisor

efforts ? Introduction of accountability culture ?

 Or because additional compensation outweighs

revenues made form “survival strategies”

 Is RBF more effective with management

autonomy ?

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• 4. Outcome Indicators

 Quality of maternal care:

 Direct indicators:

 Rate of comprehensivenesss of antenatal visists  Rate of adequate obstetrical referrals  Case fatality rate of obstetrical cases

 Proxies:

 Skills and knowledge of staff  Satff presence  Availability of drugs and equipment

 Utilization of maternal care by the poorest

 Rate of antenatal care visits (1-4) Taux de CPN 4  Rate of assisted deliveries  C-section rate

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• 5. Identification Strategy/Method

 RBF implemented in 8 districts:

 4 “treatment”  4 “control”

 Selection of districts:

 1. Pair matching of the existing 34 districts,

according to staff density and population revenues (and other variables)

 2. Selection of 4 pairs, according to maternal

health indicators and presence of donors

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• 6. Sample and data

 In the 8 districts, will be surveyed:

 About 160 facilities (all)  About 800 health workers  About 2400 household (sampling similar to DHS)

 Instruments:

 Facility survey

 With emphasis on drug management

 Health workers survey

 Questionnaire on motivation  Skills tests  Vignettes and DCO  Unannounced visits (for measuring absenteism)

 Patients exit survey  Household survey

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• 7. Time Frame/Work Plan

 Impact evaluation:

 Baseline:

Feb-May 2010

 Firm for data collection currently being contracted  Draft questionnaires ready

 Follow-up No.1:

Mai-Aout 2011

 Follow-up No.2:

Mai-Aout 2012

 RBF program:

 Start:

Juillet 2010

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• 8. Sources of Financing

 RBF programme:

 IDA World Bank  RBF fund Norway

 Evaluation d’impact:

 SIEF  RBF fund Norway