Health Results-Based Financing Impact Evaluation 2012
Health Facility Baseline Survey
Scaling-up of performance-based financing (PBF) schemes across sub-saharan Africa has developed rapidly over the past few years. Many studies have shown a positive association between PBF and health service coverage, and some with improvements in quality. However, a lack of controls and confounders in most studies that have been published on PBF initiatives means that the impact of PBF initiatives on service coverage, quality and health outcomes remains open to question. Moreover, few studies have examined the factors that influence the impact of PBF- an area of considerable operational significance since PBF often involves a package of constituent interventions: linking payment and results, independent verification of results, managerial autonomy to facilities and enhanced systematic supervision of facilities. As a result, the policy objectives of the following Impact Evaluation are to: (a) identify the impact of 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 results from the impact evaluation will be useful to designing national PBF policy in Cameroon and will also contribute to the larger body of knowledge on Performance-based Financing (PBF).
The impact evaluation is a blocked-by-region cluster-randomized trial (CRT), having a pre-post with comparison design. The evaluation relies primarily on experimental control to answer the main research questions for this study. Individual health facilities in each region have been randomized to one of the 4 study groups. Individual public and private primary care health facilities in 14 districts from the 3 pilot regions have been randomly assigned to each study group to create a factorial study design.
The evaluation relied on two main sources of data:
- Household surveys: A household survey was implemented at baseline (i.e., before implementation of PBF begins), and at endline (i.e., after PBF has been implemented for two years).
- Facility-based surveys: A facility-based survey was implemented at baseline and at endline.
Note: The Household Baseline Survey is available online under Impact Evaluation Surveys Collection. The study is titled "Health Results-Based Financing Impact Evaluation 2012, Household Baseline Survey."
Kind of data
Sample survey data [ssd]
Littoral, North-West, South-West and East regions of Cameroon.
Unit of analysis
Public and private health facilities (providing primary and/or secondary care).
Producers and sponsors
Damien de Walque
Paul Jacob Robyn
The facility survey will be conducted at baseline and endline in all public CMAs, CSIs and District Hospitals in the 14 districts included in the impact evaluation and a sample of private facilities in these districts. Based on a health facility mapping exercise conducted prior to the baseline survey, there was a total of 242 primary care facilities and 20 secondary care facilities (district and private hospitals) in the 14 districts included in the impact evaluation. Primary care and secondary care facilities combined, this included 81 in the East, 91 in the North-West and 88 in the South-West for a total of 262. Out of these, 40 were private for profit facilities. As private for-profit facilities were added to the sample after the signature of the contract with IFORD (baseline survey firm), it was decided that a random sample of 20 primary care private for-profit facilities and all private hospitals would be taken, due to budget constraints. Thus the target number of facilities was 222 primary care facilities and 20 secondary care facilities (district hospitals and private hospitals). All facility team visits will be unannounced. The facility-based survey includes multiple components, described below.
Deviations from sample design
The original expected sample - based on a minimum of 5 respondents for each module in each sampled facility- was in fact unrealistic given (i) the realities of the demand and supply of health services in the study districts and the (ii) data collection plan and budgeting. Due to budget constraints, each health facility was only visited for one day during unannounced visits. Thus the survey teams were limited to the number of patients and providers that were present on the day of the survey.
Overall, 93.8% of targeted facilities were surveyed. The remaining 6% were either inaccessible or not functional (closed down) at the time of the survey.
Dates of collection
Mode of data collection
Components of the health facility baseline survey included the following surveys:
- Facility assessment module (F1): The facility assessment module seeks to collect data on key aspects of facility functioning and structural aspects of quality of care. The respondent for this module are individuals in charge of the health facility at the time when the survey team visits the health facility.
- Health worker interview module (F2): A stratified random sample of clinical health workers with maternal and child health service delivery responsibilities at sampled health facilities was interviewed as part of this module.
- Observations of patient-provider interaction module (F3 and F4): The purpose of this module is to gather information on what health workers actually do with their patients.
- Patient exit interviews (F5, F6 and F7): A systematic random sample of patients visiting the facility (an expected 5 patients aged under-five and 5 patients aged over 5) for curative care with a new complaint will be interviewed to assess the patient's perception of quality of care and satisfaction at all 245 primary care facilities surveyed. If the patient is a child, the child's caregiver will be interviewed. The 5 under-fives included in the patient exit sample will be the same 5 children whose consultation with a provider was observed. In addition to this, exit interviews will be conducted with all ANC clients whose consultation with a provider was observed.
Damien de Walque
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Damien de Walque, The World Bank. Health Results-Based Financing Impact Evaluation, Health Facility Baseline Survey (RBFIE-FBL) 2012. Ref. CMR_2012_RBFIE-FBL_v01_M. Dataset downloaded from [URL] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.