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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:
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Performance-Based Financing | Experimental | At least one primary healthcare centre per ward and one General Hospital per selected LGA (in 50% of LGAs in each of the 3 states) and one secondary hospital per State will be contracted by the State Primary Health Care Development Agency ) , to deliver specified services at an agreed price. Selection of which services to focus on is based on priorities identified by the Federal Government of Nigeria and the states in 2010-2015. Initial prices for each service were based on shadow prices of providing the service and have been adjusted based on implementation experience. |
|
| Decentralized Facility Financing | Experimental | In the other half of the LGA's in each treated state, at least 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. |
|
| Control | No Intervention | This is a pure control arm with no additional interventions. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Performance-Based Financing | Behavioral | Incentive-based payments |
| |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | Each health facility assessed over a period of two days. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | Each health facility assessed over a period of two days. |
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Inclusion Criteria:
Exclusion Criteria:
1. None.
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| Name | Affiliation | Role |
|---|---|---|
| Eeshani Kandpal, PhD | World Bank | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34544415 | Derived | Khanna M, Loevinsohn B, Pradhan E, Fadeyibi O, McGee K, Odutolu O, Fritsche GB, Meribole E, Vermeersch CMJ, Kandpal E. Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria. BMC Med. 2021 Sep 21;19(1):224. doi: 10.1186/s12916-021-02092-4. |
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| Decentralized Facility Financing |
| Behavioral |
Financing not linked to service delivery. |
|
| 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. |
| 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. | Each health facility assessed over a period of two days. |