EVALUATION DESIGN

In 2013, the World Bank and the government of Burkina Faso launched a Performance-Based Financing (PBF) pilot program. The program objectives are to improve the utilization and quality of maternal, newborn child health (MNCH) services in six regions and twelve districts in the rural zones of Burkina Faso. In addition to the traditional PBF, the pilot program includes two demand-side interventions: 1) a community-based insurance, and 2) subsidized health services for poor and vulnerable populations. The program will systematically target these populations in order to measure its effect on the coverage, quality, and equity of health services across socio-economic groups. The combined effect on MNCH services of the PBF and the two demand-side interventions will be assessed by an impact evaluation.

The evaluation design used to estimate the impact of the program is a block-by-region cluster randomized trial with a pre-post comparison group. In this design, the comparison group will consist of facilities in neighboring pure control districts. The study will compare four treatment arms to differentiate the effects of the various features of the PBF program. In the first treatment, health facilities will receive the traditional PBF package with payments linked to the achievement of a specific set of results. In the second arm of the study, the intervention features a traditional PBF, systematic targeting, and subsidized health services for the poor. The health facilities randomly allocated to the second arm will therefore utilize the same institutional framework as those in the first; however, payments to the health facilities will be linked to the provision of care for vulnerable households in the health facility catchment areas. The third arm of the study will add a higher reimbursement rate to the factors in the second, in addition to the traditional PBF package together with systematic targeting and subsidized health services). This will act as a financial incentive for health care providers to take personal initiative to increase utilization of health care by the poorest households. In the last group of the study, a traditional PBF, combined with a community-based health insurance will be implemented. Within this group, both subsidies and systematic targeting of the poor will be channeled through health insurance programs. The health facilities will receive payment for services provided plus financial incentives to provide healthcare for the poorest households.

FINDINGS

The baseline survey was completed in March 2014. The endline survey will be completed by July 2017 and the results of the evaluation will be disseminated in 2018.