Tajikistan - Health Results Based Financing Impact Evaluation 2018

The 2018 endline survey of the impact evaluation (IE) for Health Performance-Based Financing (PBF) in Tajikistan sought to ascertain: (i) the impact and cost-effectiveness of the PBF model implemented in Tajikistan; and (ii) whether PBF is more effective or cost-effective if implemented in conjunction with additional low-cost interventions (Collaborative Quality Improvement, Citizen Report Cards). The results from the IE will help inform the Ministry of Health on whether PBF should be scaled-up to additional PHC level institutions in other regions. The Collaborative Quality Improvement intervention responds to policy concerns that performance incentives may not produce the desired improvements if providers lack the necessary competencies to inform decisions and knowledge. The Citizen Report Card attempts to improve the effectiveness of PBF by strengthening the 'short route' of accountability (e.g., by increasing accountability of health facilities to their local constituents). Since PBF, collaborative quality improvement (CQI), and citizen report cards (CRC) have never been implemented on a large scale in Tajikistan, it is to be expected that the results from the IE will be useful for designing national PHC policy in Tajikistan, and that they will also contribute to the larger body of knowledge on these interventions. The IE employs both difference-in-difference and experimental approaches to identify the impact of the different combinations of interventions. Assignment to PBF was not random. Three districts in the Sughd region and four districts in the Khatlon region were selected to implement the program. All Rural Health Centers (RHCs) in these seven districts are covered by the program. Nine additional districts (two in Sughd and seven in Khatlon) were selected as control districts. The selection of the control districts was guided by geographical proximity to treatment districts and similarity in terms of number of health facilities and doctors per capita. The districts were also selected such that the number of RHCs in treatment and control groups in each region would be similar. Within the chosen 16 districts (treatment and control districts), clusters consisting of an RHC and its subsidiary Health Houses were randomly assigned to implement Collaborative Quality Improvement, Citizen Score Cards, or neither of these two interventions. The randomization was blocked by district. In sum, RHCs were assigned into six study arms. The goal of the facility-based survey is to measure multiple dimensions of quality of care and collect detailed information on key aspects of facility functioning. Household surveys are primarily used to measure health service coverage at the population level as well as select health outcome indicators measured through anthropometry or tests. The surveys also collect broader data on the health of the households, health seeking behaviors and barriers to use of health services. In addition, PBF and other administrative data would be used to track outcomes over time in the treatment groups 1-3 (the ones receiving performance-based payments). The endline (follow-up) survey took place three years after project implementation. The survey is largely based on the HRITF instruments that were modified to the Tajik and project context.

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Author Gil Shapira; The World Bank DECHD, Damien de Walque; The World Bank DECHD
Last Updated May 21, 2020, 12:27 (UTC)
Created March 16, 2020, 11:58 (UTC)
Release Year 2019-11-12 08:27:40