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 BENIN HRBF Names of Team Members Cape Town, South Africa December 2009 Human Development Development Impact Africa Spanish Impact Network Evaluation Initiative Region Evaluation Fund
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 2
2. Result chain Activities Products Outcomes Long term outcomes • Increasing • RBF payments (for • Improving • Decreasing quality of staff bonuses, for staff motivation maternal and maternal care purchasing drug neonatal • Improving and training) mortality • Increasing staff skills utilization of • Training programs • Improving maternal care in management and availability of among the clincial skills drugs poorest • Incentives for retention of qualified staff in rural areas 3
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 ? 4
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 5
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 6
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 7
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 8
8. Sources of Financing RBF programme: IDA World Bank RBF fund Norway Evaluation d’impact: SIEF RBF fund Norway 9
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