EVALUATION DESIGN

Since 2014, the World Bank and the government of Nigeria have implemented a Results-Based Financing (RBF) project, with the goal of increasing the delivery and use of high impact maternal and child health interventions, and improving quality of care at selected health facilities. A key feature of the RBF program in the Nigerian context is the provision of financial incentives to states and Local Government Agencies (LGAs) based on results achieved. This approach seeks to build institutional capacity by introducing a culture of performance excellence both at the health facility as well as at higher levels of health systems management.  Given the innovative nature of the RBF mechanism, an impact evaluation is included in the project. This evaluation seeks to measure the impact of the RBF approach on the access, coverage, quality, and utilization of key maternal and child health services, as well as the program’s effect on infant and child health outcomes.

The impact evaluation uses a pre-post experimental design to compare outcomes of interest in two intervention arm relative to one control group. The two intervention arms are a traditional PBF package and a decentralized facility financing (DFF) scheme, which finances the same packages of services as the PBF intervention. However, under the DFF, the payments to facilities are fixed at the estimated average earned by PBF facilities. Additionally, the funds received by the health facilities implementing the DFF can be used to finance operational costs but cannot be used for bonuses to staff. In each of these two intervention groups, LGAs in the project states of Adamawa, Nasarawa and Ondo are randomly assigned. A control state is selected for each of the three project states based on similarities in health outcomes and socio-economic indicators. Half of the LGAs in each control state are randomly selected to be a part of the evaluation.

FINDINGS

The quantitative and qualitative baseline survey were conducted. The baseline and midline report will be available in the summer of 2017. A follow-up survey will be conducted in the summer of 2017, with results expected to be disseminated in early 2018.