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RBF Definition

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RBF Definition

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  1. The impact of performance-based financing on the delivery of HIV testing, prevention of mother to child transmission and antiretroviral delivery in the Cameroon health systemInternational AIDS Conference, Amsterdam, July 24, 2018Damien de Walque, Paul Jacob Robyn, Hamadou Saidou, Gaston Sorgho, Maria Steenland

  2. RBF Definition • Results-Based Financing (RBF)is a cash payment or nonmonetary transfer made to a national or sub-national government, manager, provider, payer or consumer of health services after predefined results have been attained and verified. • RBF is an umbrella term that encompasses various types of interventions that target beneficiaries (for example, conditional cash transfers), providers (for example, performance-based financing), and country governments (for example, cash on delivery).

  3. Impact Evaluation Methods

  4. Treatment groups (looking into the PBF black box) • T1 • PBF group with performance-based bonuses provided to health workers • C1 • Same amount of financial resources as the PBF group, but not linked to performance; same level of supervision and management autonomy as T1 • C2 • No additional resources but the same level of supervision as the PBF group; however, these facilities did not have management autonomy • C3 • Status quo

  5. Intervention group comparison

  6. HIV specific indicators and payments (500 FCFA ~= 1 US $)

  7. Public randomization ceremony to assign each facility to one of 4 groups • A ceremony took place in each region • North West: February 2012 • South West: April 2012 • East: July 2012 • All heads of the health facilities in the evaluation districts participated

  8. Impact evaluation methods • Regions • North West (Districts: Fundong, Kumbo East, Ndop, Nkambe) • South East (Districts: Buea, Kumba, Limbe, Mamfe) • East (Districts: Kette, Doume, Abong-mbang, Lomie, Messamena, Nguelemendouga) • 200 primary health facilities (+ district hospitals and private health facilities) • All public health facilities • A sample of private health facilities • All of the primary care health facilities were randomized into 4 treatment groups; all hospitals were assigned to PBF

  9. Impact evaluation surveys • Health facility survey at baseline (2012)/and at endline (2015) • Facility evaluation (number and type of staff, equipment, availability of medicine, supervision) • Health worker survey • Direct observation of consultations (Antenatal care, <5 consultations, outpatient adult consultations) • Exit interviews (Antenatal care, <5 consultations, outpatient adult consultations) • Household survey at baseline (2012)/and at endline (2015) • A random sample of 16/20 households in each health facility catchment area • Households with at least one woman who had been pregnant in the previous 24 months were eligible for inclusion • Health service use • Good balance across 4 study groups at baseline

  10. Health facility survey results

  11. Facility results summary Negative result : ✓ = *,✓✓ = ** ✓✓✓ = ***; Postive result : ✓ = *, ✓✓ = **, ✓✓✓ = ***

  12. HIV Testing * p < 0.1, ** p < 0.05, *** p< 0.01

  13. Prevention of Mother to Child Transmission

  14. Antiretroviraltreatment * p < 0.1, ** p < 0.05, *** p< 0.01

  15. Questions?

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