EVALUATION DESIGN

The Ghana Maternal and Child Health and Nutrition Improvement Project (MCNHP) includes a community performance-based financing (CPBF) pilot which is aimed at increasing the supply and demand of maternal and child health and nutrition (MCHN) services at the community level, namely the Community-based Planning and Services (CHPS) zone. The CPBF entails the provision of monetary incentives based on pre-defined MCHN indicators to Community Health Teams (CHTs) comprising Community Health Officers (CHO) and Community Health Volunteers (CHV).

METHODS

The Impact Evaluation (IE) aims to measure the impact of the CPBF on health provider behavior and maternal and child health and nutrition indicators. A two-armed multi-site cluster randomized control design in the 8 pilot districts will be used to measure the effect of the program. The randomization is at the sub-district level, whereby all CHPS zones within a sub-district are randomized into either the intervention or control group. A cluster of CHPS zones by sub-district was adopted as the intervention unit in order to attempt to reduce spillover across CHPS and to facilitate the operational roll-out. The intervention group includes CHTs that receive material and financial inputs to support operational activities (known as the “MCHNP base” funding), in addition to the CPBF incentives. In the control group, CHTs only receive material and financial resources. This design does not include a pure control group (i.e. sub-districts or CHPS zones receiving no inputs whatsoever), since the majority of the country features some form of a support intervention at the CHPS level.

The CPBF includes six surveys, on the supply and demand side. On the supply side, a Health Center, Community Health Team (CHT), and Community Health Officer (CHO)/ Community Health Volunteer (CHV) survey are implemented. On the demand side, a Community, Household and Patient Exit Interview survey are rolled out. As part of the CHO/CHV survey, a Discreet Choice Experiment is implemented to gain insights into the motivating factors and challenges facing human resources at the CHPS zone level.

Although some delays in the rollout of the CPBF pilot have occurred, the baseline data was collected between June and November 2016. The endline survey is planned for June-November 2018.