The World Bank and the government of Nigeria are implementing a results-based financing (RBF) project for the states of Nasarawa, Adamawa, and Ondo. This project provides incentives for improving performance at critical levels within the Nigerian health system and aims to address some of these challenges. The primary goal of the impact evaluation of this project is to determine if providing financial incentives linked directly to performance increases the quantity and quality of maternal and child health (MCH) services. In each of the three selected States,the project finances the following interventions: 1. Performance incentives to State Government and Local Government (LGA) agencies that are triggered by Disbursement Linked Indicators (DLIs) that reflect strengthened supervision and enhanced operational support for improving health systems performance. These performance incentives would be paid out on an annual basis. 2. In half of the LGAs in each state, one facility per ward will receive Performance-Based Financing (PBF) wherein payments are made directly to individual health facilities based on the quantity and quality of a set of pre-defined services provided by each facility. These performance incentives would be paid out on a quarterly basis. 3. In the other half of the LGAs in each state one facility per ward will receive Decentralized Facility Financing (DFF) or equivalent financing that is not be linked to any service delivery targets. These payments would be made on a quarterly basis. The evaluation of the PBF arm, which consists of making payments to health facilities conditional on performance, but within an environment of comparable levels of overall financing, will rely on experimental assignment. The effect of the PBF intervention will be identified by comparing outcomes in the LGAs receiving PBF versus those receiving DFF in the three project states. In each of these three States, the LGAs will be randomly assigned to either the PBF package or to the DFF package.
A detailed description can be found in the attached project concept note.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
74
Incentive-based payments
Financing not linked to service delivery.
Utilization of priority maternal and child health services
The utilization of priority MCH services, as defined by the quantitative checklist used by the project to measure and reward facility performance.
Time frame: Each health facility assessed over a period of two days.
Utilization of priority maternal and child health services, particularly by the poor
The utilization of priority MCH services, as defined by the quantitative checklist used by the project to measure and reward facility performance, by poor households.
Time frame: Each health facility assessed over a period of two days.
Aggregated Provider Performance through Direct Clinical Observation
We use data on direct clinical observations of labor and delivery to construct an aggregate measure of provider performance.
Time frame: Each health provider assessed over a period of one day.
Aggregate Structural and Process Quality Index
The quantitative checklist used in the government program is replicated to a large degree in the impact evaluation survey. We construct independent observations on aggregate structural and process quality measures in the same fashion as the program has constructed and rewarded.
Time frame: Each health facility assessed over a period of two days.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.