| Table of contents |
ACKNOWLEDGEMENTS ......................................................................................................... 2
SUMMARY ................................................................................................................................... 6
OVERVIEW ................................................................................................................................ 14
INTRODUCTION ............................................................................................................................. 14
OBJECTIVES OF THE PBF FOR HEALTH IMPACT EVALUATION IN CAMEROON .......................... 14
CAMEROON HEALTH SECTOR CONTEXT ...................................................................................... 19
HEALTH STATUS AND SERVICE COVERAGE ..................................................................................... 20
OTHER FACTORS INFLUENCING HEALTH SERVICE DELIVERY OUTCOMES ........................................ 26
PERFORMANCE-BASED FINANCING IN CAMEROON ..................................................................... 28
IMPLEMENTATION ARRANGEMENTS............................................................................................... 29
INSTITUTIONAL FRAMEWORK OF PBF: REGULATION, PAYMENT, AND SERVICE PROVISION ... 29
REGULATION:................................................................................................................................. 29
FUNDHOLDING, PAYMENT AND VERIFICATION: .............................................................................. 29
HEALTH SERVICE PROVISION.......................................................................................................... 31
IMPACT EVALUATION METHODOLOGY ........................................................................ 37
IDENTIFICATION STRATEGY ......................................................................................................... 37
IMPACT EVALUATION DATA ......................................................................................................... 41
RANDOMIZATION CEREMONIES AND RESULTS ............................................................................ 41
SAMPLE SIZES AND SAMPLING STRATEGY FOR THE HEALTH FACILITY SURVEY ........................ 41
TIMELINE OF THE BASELINE SURVEY AND OVERALL IMPACT EVALUATION............................... 42
COMPONENTS OF THE HEALTH FACILITY BASELINE SURVEY............................. 43
FACILITY ASSESSMENT MODULE (F1) .......................................................................................... 43
HEALTH WORKER INTERVIEW MODULE (F2) .............................................................................. 43
OBSERVATIONS OF PATIENT-PROVIDER INTERACTION MODULE (F3 AND F4) ........................... 44
PATIENT EXIT INTERVIEWS (F5, F6 AND F7) ............................................................................... 44
2012 HEALTH FACILITY BASELINE SURVEY DESCRIPTIVE STATISTICS ............ 45
FINAL HEALTH FACILITY SAMPLE................................................................................................ 45
GENERAL HEALTH FACILITY CHARACTERISTICS ........................................................................ 46
HEALTH FACILITY ASSESSMENT (F1) ............................................................................. 49
SERVICE DELIVERY CHARACTERISTICS ....................................................................................... 49
FINANCIAL RESOURCES OF HEALTH FACILITIES ......................................................................... 53
EQUIPMENT AND DRUGS ............................................................................................................... 55
MANAGEMENT AND SUPERVISION ................................................................................................ 55
HEALTH WORKER SURVEY (F2) ........................................................................................ 63
HEALTH WORKER SURVEY RESPONDENT CHARACTERISTICS ..................................................... 63
HEALTH WORKER ACTIVITIES, TRAINING RECEIVED AND TRAINING NEEDED ........................... 68
REMUNERATION OF HEALTH WORKERS ...................................................................................... 75
SUPERVISION................................................................................................................................. 77
SECONDARY EMPLOYMENT .......................................................................................................... 78
HEALTH WORKER PERCEIVED WELL-BEING................................................................................ 80
HEALTH WORKER SATISFACTION ............................................................................................... 82
HEALTH WORKER PERSONAL DRIVE ............................................................................................ 83
QUALITY OF ANTENATAL CARE: DIRECT OBSERVATIONS (F3) ............................ 86
PROVIDER CHARACTERISTICS AND BACKGROUND QUESTIONS ASKED..................................... 86
ACTIVITIES PERFORMED BY HEALTH CARE PROVIDERS DURING ANTENATAL CONSULTATIONS87
QUALITY OF ANTENATAL CARE: PATIENT EXIT INTERVIEWS (F5) ..................... 96
PATIENT CHARACTERISTICS AND SELECTED BACKGROUND TREATMENT CHARACTERISTICS .. 96
PATIENT SATISFACTION ............................................................................................................. 105
QUALITY OF EXTERNAL CONSULTATIONS FOR CHILDREN UNDER FIVE YEARS OF AGE: DIRECT OBSERVATIONS (F4)....... 109
HEALTH WORKER CHARACTERISTICS ...................................................................................... 109
TREATMENT CHARACTERISTICS ............................................................................................... 110
QUALITY OF EXTERNAL CONSULTATIONS FOR CHILDREN UNDER FIVE YEARS OF AGE: PATIENT EXIT INTERVIEWS (F6) ... 118
PATIENT CHARACTERISTICS AND CONSULTATION TASKS PERFORMED AND PROVIDER CHARACTERISTICS .................. 118
TREATMENT CHARACTERISTICS ............................................................................................... 123
PATIENT SATISFACTION ............................................................................................................. 126
COMMUNITY HEALTH WORKERS .............................................................................................. 128
QUALITY OF EXTERNAL CONSULTATIONS FOR PATIENTS AGED FIVE YEARS AND ABOVE: PATIENT EXIT INTERVIEWS (F7). 130
PATIENT CHARACTERISTICS AND CONSULTATION TASKS PERFORMED AND PROVIDER CHARACTERISTICS .................. 130
TREATMENT CHARACTERISTICS ............................................................................................... 135
PATIENT SATISFACTION ............................................................................................................. 139
COMMUNITY HEALTH WORKERS .............................................................................................. 141
INTERNAL VALIDITY OF THE STUDY ............................................................................ 143
BALANCE TESTS ......................................................................................................................... 143
HEALTH FACILITY ASSESSMENT ................................................................................................ 146
SERVICE DELIVERY CHARACTERISTICS......................................................................................... 146
EQUIPMENT AND DRUGS............................................................................................................... 150
MANAGEMENT AND SUPERVISION ................................................................................................ 155
HEALTH WORKER SURVEY ......................................................................................................... 157
DIRECT OBSERVATIONS FOR ANTENATAL CONSULTATIONS ..................................................... 159
PATIENT EXIT INTERVIEWS FOR ANTENATAL CONSULTATIONS................................................ 167
DIRECT OBSERVATIONS FOR EXTERNAL CONSULTATIONS FOR CHILDREN UNDER FIVE YEARS OF AGE ...... 173
PATIENT EXIT INTERVIEWS FOR EXTERNAL CONSULTATIONS FOR CHILDREN UNDER FIVE YEARS OF AGE... 179
PATIENT EXIT INTERVIEWS FOR EXTERNAL CONSULTATIONS FOR ADULTS ............................. 183
CONCLUSIONS AND RECOMMENDATIONS FOR FOLLOW-UP SURVEY ............. 187
APPENDICES ........................................................................................................................... 188
GIS DISTRICT-LEVEL MAPS ........................................................................................................ 188
NORTH-WEST .............................................................................................................................. 188
SOUTH-WEST ............................................................................................................................... 190
EAST ............................................................................................................................................ 192
ADDITIONAL TABLES .................................................................................................................. 199
REFERENCES.......................................................................................................................... 225 |
