Despite some moderate improvements, reproductive, maternal and child health indicators continue to perform poorly in the Republic of Congo. To increase the quality and utilization of maternal and child health services, a supply-side performance-based financing (PBF) scheme was introduced. Under this scheme, the Ministry of Health and Population (MOHP) contracts and incentivizes health centers and first level referral hospitals to respectively expand the coverage and improve quality of services. The PBF payment mechanism also includes penalties to discourage fraud. In parallel, the poject is also piloting a demand-side PBF scheme, where PBF health facilities contract and incentivize community relays – composed of health facility staff and community health workers from the community – to support households in adopting positive behaviors. In collaboration with the Ministry of Health and the Ministry of Social Affairs, the World Bank team has developed a design to assess the impact of PBF interventions. The impact evaluation examines the combination of performance-based financing, community-based targeting and subsidization of health services provided to the poor and household visits, according to an established protocol. PBF is implemented at the district level (with control districts in the same departments) and the demand-side interventions are randomized at the health facility level. The baseline survey was conducted in 2014 and covered 7,800 households, 285 primary care health facilities and 35 district hospitals. The second round of the impact evaluation is planned for mid-2018; the endline survey is planned for mid-2019.
