Health Results Based Financing Impact Evaluation 2014, Health Facility Baseline Survey

A complete health facility survey was conducted in RHCs, whereas for health houses a shorter survey was implemented. A challenging and important goal of the facility-based survey is to collect different measures of quality of care in the health facilities.
Form F1: Health Facility Assessment: 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 were the individuals in charge of the health facility at the time when the survey team visits the health facility. The main themes to be covered by the facility assessment include:

· Facility staffing, including the staffing complement of the facility, staff on duty at the time of the survey team's visit and staff present at the time of the survey team's visit
· Facility infrastructure and equipment
· Availability of drugs, consumables and supplies at the health facility
· Supervision
· Record keeping and reporting to the Health Management Information System
· Service volumes

Form F2: Health Worker Questionnaire: A random sample of 4 health workers was to be taken at each of the Rural Health Centers and Health Houses included in the sample. Eligible health workers include doctors, nurses, midwife/auxiliary midwife, and any other health worker providing MCH or NCD care. In facilities with less than 4 health workers on their staff roster, all eligible health workers were to be interviewed.
The main themes to be covered by this module include:
· Role, responsibilities and characteristics of the interviewed health worker
· Staff satisfaction and motivation
· Technical knowledge on MCH and NCDs. Knowledge was assessed through the use of provider vignettes on MCH and NCD protocols and diagnosis.

Direct Observation of Patient-Provider Interactions: The goal of the direct observations is to assess adherence to protocols in terms of IMCI and hypertension management. At each Rural Health Center, up to 5 children under-five and up to 5 adults over 40 years who are potential candidates for hypertension identification/management services was to be selected. A member of the survey team observed consultations using a structured format to note whether key desired actions were carried out. In the case of patients under five, the instrument focuses on whether IMCI protocols are followed. For adults over 40 years, the instrument focuses on whether MoH and international protocols are followed. The direct observations were implemented only in RHCs.

Form F4: Patient Exit Interviews: The same set of patients who were selected for the direct observations of patient-provider interactions were also selected for exit interviews. If the patient is a child, the child's caregiver was interviewed. The exit interviews collected data on the patients' perceived quality of care and satisfaction with the care given. Additional information was collected on socio-economic background and the general health of the patient. Like the direct observations, the exit interviews were only administered in RHCs.

Criterion Based Audit: A target sample of 5 under-five and 5 adult (40+ years) medical records was selected using systematic random sampling methodology at each Rural Health Center to assess whether the content of clinical care delivered is complete and appropriate in light of clinical best practices. Each indicator in the criterion-based clinical care audit is scored through a review of patient records or other facility logs using a structured format. The criterion-based clinical audit focused on IMCI protocols (for under-fives) and hypertension screening and management (for adults over 40 years).