Health Results-Based Financing Impact Evaluation 2012
Health Facility Baseline Survey
Central African Republic
Scaling-up of performance-based financing (PBF) has never been systematically evaluated in Central African Republic (CAR) on any meaningful scale. As such, this Impact Evalution's larger policy objectives 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.
In doing so, the results from the impact evaluation will be useful to designing national PBF policy in CAR and will also contribute to the larger body of knowledge on PBF. The evaluation will rely on two main sources of data:
1. Household surveys: A household survey will be implemented at baseline (i.e., before implementation of PBF begins), and at endline (i.e., after PBF has been implemented for two years).
2. Facility-based surveys: A facility-based survey will be implemented at baseline and at endline.
The main targeted outcomes fall into two main groups:
(a) Maternal and Child Health Service coverage indicators and
(b) Quality of care indicators.
The study is a blocked-by-region cluster-randomized trial (CRT), having a pre-post with comparison design. The team relied primarily on experimental control to answer the main research questions for this study. The study will also include a qualitative component at endline to probe deeper for explanations or explore specific issues that are relevant to PBF.
Note: The Baseline Household Survey is available online under Impact Evaluation Surveys Collection. The study is titled "Central African Republic Health Results-Based Financing Impact Evaluation 2012, Baseline Household Survey."
Kind of data
Sample survey data [ssd]
PBF was implemented in public, Faith Based Organization (FBO) and not-for-profit non-governmental organization (NGO) facilities across 7 prefectures in the 2nd, 3rd, 4th and 6th regions of CAR covering a total population of approximately 2.5 million.
Unit of analysis
Public and private health facilities (providing primary and/or secondary care).
Producers and sponsors
Damien de Walque
Paul Jacob Robyn
The study is a blocked-by-region cluster-randomized trial (CRT), having a pre-post with comparison design. The research team relied primarily on experimental control to answer the main research questions for this study. Individual health facilities in each region were randomized to one of 3 study groups. Individual public and private not-for-profit Health Centers [Centres de Santé (CS)] and Health Posts [Poste de Santé (PS)] who met pre-established criteria in 7 prefectures from the 3 pilot regions were randomly assigned to each study group to create a factorial study design. This process of random allocation seeks to ensure that the two study groups are comparable in terms of observed and unobserved characteristics that could affect treatment outcomes so that average differences in outcome can be causally attributed.
The difference between a regular cluster-randomized trial (CRT) and a blocked CRT lies in the way in which the treatment units-the health facilities in this case-are randomly allocated into treatment and control conditions. In a regular CRT, health facilities would be randomly assigned into treatment and control conditions independent of the region (or prefecture) they belong to. In this blocked-by-region CRT, each region had its own randomization scheme. In other words, 3 random allocation processes, one for each region included in the evaluation (i.e., 3 blocks).
Dates of collection
Mode of data collection
- Facility assessment module : 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 is the individual in charge of the health facility at the time when the survey team visits the health facility. The full Facility Assessment module was conducted at all Health Centers and Hospitals. For Health Posts, a more simplified questionnaire that evaluates basic facility functioning was used.
- Health worker interview module : A stratified random sample of clinical and lay health workers with maternal and child health service delivery responsibilities at sampled health facilities were interviewed as part of this module. The full Health Worker module was conducted at all Health Centers and Hospitals. For Health Posts, a more simplified questionnaire was used.
- Observations of patient-provider interaction module: While the health worker interview module collects information on what health workers know, the purpose of this module is to gather information on what health workers actually do with their patients.
- Patient exit interviews : A systematic random sample of 10 patients visiting the facility (5 patients aged under-five and 5 patients aged over 5) for curative care with a new complaint were interviewed to assess the patient's perception of quality of care and satisfaction at all Health Centers surveyed. If the patient is a child, the child's caregiver was interviewed. The 5 under-fives included in the patient exit sample were the same 5 children 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. Central African Republic Health Results-Based Financing Impact Evaluation 2012, Health Facility Baseline Survey (RBFIE-FBL) 2012. Ref. CAF_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.