Cameroon PBF Impact
Evaluation
Midline Qualitative Study Protocol
Jake Robyn| Health Specialist
HSSIP project zones
Impact evaluation design
• PBF Impact Evaluation: 14 health districts where PBF has not yet been piloted as of August 2011 o Data: Household and health facility surveys
o Sample: 250 facilities and 4000 households
o Baseline survey completed in June 2012
• Research questions 1. Does the PBF program increase the coverage and of MCH
services?
2. Is it the enhanced monitoring & evaluation and supervision or the link between payments and results that leads to improvements observed in quality or coverage?
3. What is the contribution of enhanced supervision and monitoring to improving MCH service coverage and quality in the absence of increased autonomy or additional financial resources?
4. What is the cost-effectiveness of PBF in terms of improvements achieved per dollar?
Impact Evaluation study groups
T1: PBF with health
worker performance
bonuses
C2: No additional
resources but same
supervision and monitoring
as PBF arms T 1 and C1
C3: Status quo
C1: Same per capita
financial resources as PBF
but not linked to
performance; Supervision,
monitoring and managerial
autonomy as T1
60 Health Facilities 57 Health Facilities
56 Health Facilities 60 Health Facilities
Impact evaluation timeline
Concept Note
Finalize Program and IE Design
IE Baseline
Implement RBF
IE Endline
Analysis and
Dissemination
IE Qualitative
midline
2011 2012 2013 2014 2015
Cameroon midline qualitative study
• The Cameroon midline qualitative study focuses on two
primary themes:
o Experiences in the piloting of PBF at the central, regional and district level:
perspectives of decision-makers and policymakers
o Experiential elements of health service delivery at the operational level:
perspectives of patients and providers
Sampled stakeholders
• Purposive Sampling in all 4 Regions:
o Northwest
o Southwest
o East (IE districts only)
o Littoral
Interview guides for each target group
• Policymakers, administrative leaders and development
partners o What have been the challenges, bottlenecks and successes during the
preparation of the pilot and first year of implementation?
• Operational level o How have PBF implementers at the operational level, such as Performance
Purchasing Agencies and district health management teams, experienced PBF
during the first year of operations?
• Service delivery level (T1, C1, C2, C3) o How have providers’ experiences with quality of care changed since the
introduction of PBF?
o How have community members and patients experiences with quality of care
changed since the introduction of PBF?
o How have community leaders and community health workers experiences with
quality of care changed since the introduction of PBF?
o
• Data Transcription: Hire an independent transcription
firm
Data Collection • 136 total interviews
• 120 In-Depth Interviews (IDIs)
• One-on-one key informant interviews
• 16 Focus Group Discussions (FGDs) • Community-focused
• Captures complex ideas in-depth
• Captures a variety of views and opinions
Sampling Methodology PBF in Cameroun: Mid-line Qualitative Study Interview Format Total IDIs Total FGDs
Proposed Sampling and # of IDIs and FGDs IDIs FGDs
Central Level
Ministry of Health 2 x 2
Development Partners 2 x 2
Regional Level (4 TOTAL Regions: NW, SW, Littoral, and East)
Regional Health Delegates 1 x 4
District Medical Officers 2* x 8
IE Study Groups (T1, C1, C2 and C3)
District Hospitals and Primary Health Centres (Directors and Administrators) 18** x 72
Community Level
Community Leaders 2*** x 32 x
Community Members, Health Workers, etc. x 4/region*** 16
* 2 DMOs per region
**Stratifed by IE Study Group; 18 total IDIs per region
***Following FGD catchment (2 per village/4 villages total/8 per region) GRAND TOTALS for Midline Qualitative Study
****Stratifed by T1/C3 IE Study Groups; Urban/Rural; Female only IDIs 120
FGs 16
136 interviews TOTAL
Health facility sampling
o IDI Sampling - Health Facility Level (18 per region, 72 total)
• The sample of district hospitals and primary care health facilities will be
sampled per IE study group.
T1 C1 C2 C3
Urban Rural Urban Rural Urban Rural Urban Rural
Public 1 1 1 1 1 1 1 0
Confessional 1 1 1 1 0 1 1 1
Private 1 1 0 0 1 0 0 1
Total 6 4 4 4
Community IDI sampling
• IDI Sampling – Community Level (32)
• Key Informants o Women’s Group Leader
o Community Member of Health Centre Committee
T1 C3
Urban Rural Urban Rural
Women’s Group Leader 1 1 1 1
Community Member of
HCC 1 1 1 1
8 per region, and 32 countrywide
Focus group dicsussions • Focus Group Discussions Sampling and Distribution:
o T1/C3 Catchment Areas
o Urban/Rural Stratification
o Female Only (MCH)
• FGDs Themes: • Health-seeking behaviors
• Current Experience with Health Facilities
• Improvements and Looking Ahead
T1 C2 Urban Rural Urban Rural Female Female Female Female
1 1 1 1
4 per region, and 16 countrywide
Data analysis and writing • Coding
o NVivo 10 qualitative analysis software
• The qualitative study core team will work together to ensure
reliability and validity of coding.
• The analysis process begins with data collection,
transcription, working with the data directly, and writing.
• Report will be completed and disseminated by June 2014.