Impact Evaluation Note Lesotho Mamoruti Theli and Leutsoa Matsoso

H E A LT H R E S U LT S I N N O VAT I O N T R U S T F U N D

Background

•  Small landlocked country, 1.9m •  Mountainous terrain •  High maternal (1,155/100,000 births) and under-five

mortality (86/1,000 births) •  3rd highest HIV prevalence (23.2%) •  Two main service providers (Public and CHAL) •  10 districts (capital district excluded from PBF)

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Description of Intervention

•  Improving MNH services via incentive payments o  Health centers together with VHWs (quantity, quality and

remoteness) o  District hospitals (quantity, and quality) o  DHMTs for supervision

•  3 phases o  Phase 1 ( 2 districts, not part of impact evaluation) o  Phase 2 (additional 4 districts, 1 year after Phase 1) o  Phase 3 (additional 3 districts, 2 years after phase 1)

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Primary Research Questions

•  What is the causal effect of the PBF program on o  quantity of MNH services o  quality of MNH services o  health outcomes ?

•  What is the cost-effectiveness of PBF vs. additional health financing not tied to performance?

•  Does the PBF program reduce inequity?

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Outcome Indicators

•  % institutional deliveries •  % fully immunized •  % women using modern contraceptives •  Quality of care score •  Weight-for-age, height-for-age •  Prevalence of anemia

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Randomized phase-in design

Full PBF package:   Linking payments and

results   Managerial autonomy

within defined limits   Systematic supervision

Additional Resources:   Not tied to performance   Equaling average

resources of treatment   Follow existing guidelines

about use of funds   Switch to PBF when study

ends!

Treatment Control

Health centers will be randomized into 2 study groups:

Sample

Households with women of childbearing age

Health Centers

Study Arms

PBF IE

Treatment

1 2 … 44

1 2 …

…

25

0

Control

1 2 … 44

Total: 88 health centers, up to 2,200 households

Data: Household Surveys Sample: •  Households in catchment areas served by the control and

treatment facilities •  The selected household will have a woman with a recent

pregnancy

Survey components: •  Household roster and socioeconomic status •  Utilization and health behaviors regarding MNH services •  Household health expenditure •  Perceptions of health service quality •  Anthropometry and biomarker: and anemia

Timeline Phase  2    districts   Phase  3  districts  

Treatment   Control   Treatment   Control  

Implementa)on   Survey   Implementa)on   Survey   Implementa)on   Survey   Implementa)on   Survey  

2015    

Q1   Baseline   Baseline  Q2  

Q3  

Full  PBF  

Add

i;on

al  Finan

cing  

Q4  

2016    

Q1   Baseline   Baseline    Q2  

Q3  

Full  PBF  

Add

i;on

al  Finan

cing  

Q4  

2017    

Q2  

Q3  

Q4  

Q1  

2017    

Q2  

Endline   Endline  Q3   Endline   Endline    

Q3  Full  PBF   Full  PBF  

Q4