Health Results Based Financing Impact Evaluation 2018, Household Follow-up (Endline) Survey
Household Follow-up (Endline) Survey
The policy objective of the Impact Evaluation (IE) is to build evidence on the impact and cost-effectiveness of the proposed Performance-Based-Financing (PBF) project in Tajikistan. More specifically, the IE would seek to ascertain: (i) the impact and cost-effectiveness of the PBF model implemented in Tajikistan; and (ii) whether PBF is more effective or cost-effective if implemented in conjunction with additional low cost interventions (Collaborative Quality Improvement, Citizen Report Cards). The results from the IE will help informing the MOH on whether PBF should be scaled-up to additional PHC level institutions in other regions.
The Collaborative Quality Improvement intervention responds to policy concerns that performance incentives may not produce the desired improvements if providers lack the necessary competencies, data to inform decisions and knowledge. The Citizen Report Card attempts to improve the effectiveness of PBF by strengthening the 'short route of accountability', i.e., by increasing accountability of health facilities to their local constituents. Since PBF, collaborative quality improvement (CQI), and citizen report cards (CRC) have never been implemented in large scale in Tajikistan, it is to be expected that the results from the IE will be useful for designing national PHC policy in Tajikistan, and that they will also contribute to the larger body of knowledge on these interventions.
The IE employs both difference-in-difference and experimental approaches to identify the impact of the different combinations of interventions. Assignment to PBF was not random. Three districts in the Sughd region and 4 districts in the Khatlon region were selected to implement the program. All Rural Health Centers (RHCs) in these seven districts are covered by the program. Nine additional district (two in Sughd and seven in Khatlon) were selected as control districts. The selection of the control districts was guided by geographical proximity to treatment districts and similarity in terms of number of health facilities and doctors per capita. The districts were also selected such that the number of RHCs in treatment and control groups in each region would be similar.
Within the chosen 16 districts (treatment and control districts), clusters consisting of a RHC and its subsidiary Health Houses were randomly assigned to implement Collaborative Quality Improvement, Citizen Score Cards, or neither of these two interventions. The randomization was blocked by district. In sum, RHCs were assigned into six study arms.
The goal of the Facility-based survey is to measure multiple dimensions of quality of care and collect detailed information on key aspects of facility functioning.Household surveys are primarily used to measure health service coverage at the population level as well as select health outcome indicators measured through anthropometry or tests. The surveys also collect broader data on the health of the households, health seeking behaviors and barriers to use of health services. In addition, PBF and other administrative data would be used to track outcomes over time in the treatment groups 1-3 (the ones receiving performance-based payments).
Kind of data
Sample survey data [ssd]
Selected districts in Sughd and Khatlon regions (provinces) in Tajikistan
At baseline, three districts in the Sughd region and 4 districts in the Khatlon region were selected to implement the program. All Rural Health Centers in these seven districts are covered by the program. Nine additional district (two in Sughd and seven in Khatlon) were selected as control districts. The selection of the control districts was guided by geographical proximity to treatment districts and similarity in terms of number of health facilities and doctors per capita. The districts were also selected such that the number of RHCs in treatment and control groups in each region would be similar.
Unit of analysis
Producers and sponsors
Damien de Walque
Health Results Innovation Trust Fund
Field coordinator/ research assistant
Households in catchment areas of selected Rural Health Centers and affiliated Health Houses were randomly selected to be included in the sample if (1) a household member was pregnant in the two years prior to the survey; (2) a household member is above 40 years old.
Confidentiality of respondents is guaranteed by Articles N to NN of the National Statistics Act of [date].
Before being granted access to the dataset, all users have to formally agree:
1. To make no copies of any files or portions of files to which s/he is granted access except those authorized by the data depositor.
2. Not to use any technique in an attempt to learn the identity of any person, establishment, or sampling unit not identified on public use data files.
3. To hold in strictest confidence the identification of any establishment or individual that may be inadvertently revealed in any documents or discussion, or analysis. Such inadvertent identification revealed in her/his analysis will be immediately brought to the attention of the data depositor.
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
Shapira, Gil., Damien de Walque. 2018. Tajikistan Health Results Based Financing Impact Evaluation 2018, Household Baseline Survey (HRBFIE-HEL 2018). Ref. TJK_2018_HRBFIE-HEL_v01_M.The World Bank. 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.