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Health Results-Based Financing Impact Evaluation 2012, Health Facility Endline Survey [Data set]. World Bank, Development Data Group, World Bank","funding_agencies":[{"name":"Health Results Innovation Trust Fund (HRITF)","abbr":"","role":""}]},"series_statement":{"series_name":"Administrative Records, Health (ad\/hea]","series_info":"Results-Based Financing Impact Evaluation Health Facility Endline Survey"},"version_statement":{"version":"Data collection for the Cameroon PBF IE health facility and household endline surveys were conducted in 2015 by IFORD (Institute of Demographic Training and Research) in Yaounde, Cameroon with administrative and technical support from the Ministry of Health and World Bank.","version_date":"2015-12-31"},"study_info":{"abstract":"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).\n\nThe 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.\n\nThe evaluation relied on two main sources of data:\n- 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).\n- Facility-based surveys: A facility-based survey was implemented at baseline and at endline.","coll_dates":[{"start":"2015-04-12","end":"2015-07-22","cycle":""}],"nation":[{"name":"Cameroon","abbreviation":"CMR"}],"geog_coverage":"14 health districts across North-West (4), South-West (4) and East (6) regions.","analysis_unit":"Public and private health facilities (providing primary and\/or secondary care)","data_kind":"Sample survey data [ssd]","notes":"259 primary and secondary care facilities in the 14 districts included in the IE. The facility-based survey comprised different tools for data collection with different data sources and respondents: Health facility records, providers' questionnaire, direct observations (curative consultations of under-5 and antenatal consultations), exit interviews (curative consultations and antenatal consultations)"},"method":{"data_collection":{"data_collectors":[{"name":"Pr. BENINGUISSE Gervais","abbr":"","role":"","affiliation":"IFORD"}],"sampling_procedure":"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.","sampling_deviation":"The original expected sample: \n- based on a minimum of 5 respondents for each module in each sampled facility\n- 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.","coll_mode":["Computer Assisted Telephone Interview [cati]"],"research_instrument":"Facility-based survey\nThe facility survey was conducted in all the CMAs, CSIs and District Hospitals in the 14 districts included in the impact evaluation. All facility team visits were unannounced. The facility-based survey included multiple components. The sample of health workers, patient-provider observations and client exit interviews was selected to enable findings from these three components to be linked.\n\nFacility assessment module\nThe facility assessment module collected data on key aspects of facility functioning and structural aspects of quality of care. The individual in charge of the health facility at the time when the survey team visited the health facility was asked to be the respondent for this survey module. The main themes that were covered by the facility assessment included:\n\n\u2022 Facility staffing, including the staffing complement of the facility, staff on duty at the time of the survey team\u2019s visit and staff present at the time of the survey team\u2019s visit \n\u2022 Facility infrastructure and equipment \n\u2022 Availability of drugs, consumables and supplies at the health facility\n\u2022 Supervision \n\u2022 Record keeping and reporting to the Health Management Information System\n\u2022 Facility management\n\u2022 Official user charges at the facility\n\u2022 Revenues obtained at the health facility, and how revenues have been used\n\nHealth worker interview module\nFor health facilities with more than five health workers, a list of all clinical staff who worked in the area of maternal and child health providing prenatal or under five consultations was obtained. If this list contained more than five people, study enumerators interviewed a random sample of these health workers. If the list contained fewer than five people, all clinical personnel working in maternal and child health were interviewed. The interviews focused on the following areas:\n\n\u2022 Role and responsibilities of the interviewed health worker\n\u2022 Compensation, including delays in salary payments\n\u2022 Staff satisfaction and motivation\n\nObservations of patient-provider interaction module\nWhile 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.  \n\nA member of the survey team observed consultations with a systematic random sample of patients under five presenting with a new condition (i.e., not for follow-up visits or routine) and new ANC clients. The observer used a structured format to note whether key desired actions were carried out. In the case of patients under five, the instruments were focused on whether IMCI protocols are followed. For ANC clients the instruments examined whether key desired actions (including counseling) were carried out. As primary care facilities do not offer ANC services on all days of the week \u2013 typically these are offered 2 days each week \u2013 the ANC module was not conducted at all health facilities. During the baseline survey, 5 under-5 and 5 ANC observations were conducted at each facility where these modules are implemented. After finding that many health facilities did not offer ANC on the day of the survey at baseline, during the endline survey enumerators were asked to interview as many women receiving ANC on the day of the survey as possible to increase the sample size. All health workers selected for patient-provider observations will be included in the health worker interview sample. \n\nPatient exit interviews\nEnumerators conducted an exit interview with all patients whose consultation was observed as part of the study procedures. If the patient was a child, the child\u2019s caregiver was interviewed. The under-fives included in the patient exit sample were the same children whose consultation with a provider was observed.  In addition to this, exit interviews were conducted with all ANC clients whose consultation with a provider was observed."}},"data_access":{"dataset_use":{"contact":[{"name":"ddewalque@worldbank.org","affiliation":"","email":"","uri":""},{"name":"probyn@worldbank.org","affiliation":"","email":"","uri":""}],"cit_req":"Damien de Walque, The World Bank. Results-Based Financing Impact Evaluation, Health Facility Endline Survey (RBFIE-FEL) 2015. Ref. CMR_2015_RBFIE-FEL_v01_M. 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