Impact Evaluation Note
Country
Dr Tayyab Massod !
Dr Akhtar Rashid
H E A LTH R ESU LTS IN NOVATION TRUS T FU N D
1.  Background
•  Punjab’s health outcomes have improved but the pace of change
remains slow.
•  Punjab’s under-five and i...
1.  Background
•  GoP has approved a health sector strategy
•  The Bank and DFID are supporting this with a $285m
investme...
2. Description of Intervention
•  Facility Based Performance Incentives:
o  To enhance performance and improvements in qua...
3. Results Chain
o  Cash
Transfers to
facilities…
INPUTS ACTIVITIES OUTPUTS OUTCOMES
LONGER-TERM
OUTCOMES
HIGHER ORDER
GOA...
3. Results Chain
o  Awareness
of services,
o  Incentive to
provider and
consumer
INPUTS ACTIVITIES OUTPUTS OUTCOMES
LONGER...
4. Primary Research Questions
•  Can RBF approaches increase the level of health service
utilization leading to better hea...
5. Outcome Indicators
•  District Management Contracts
o  performance indicators related to delivery of essential package ...
6. Identification Strategy/ Method
•  Multiple Research methods include
o  Data collection will be on a prospective basis,...
7. Sample and Data
•  The Universe is the worse off 18 out of 36 Districts in
Punjab
•  The data collection will be done i...
8. Time Frame / Work Plan
•  Ac#vity	
   TimeLine
•  Project	
  team	
  on	
  board	
   June 2014
•  I.E	
  team	
  	
   J...
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Annual Results and Impact Evaluation Workshop for RBF - Day Eight - Impact Evaluation Note - Pakistan

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A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

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Annual Results and Impact Evaluation Workshop for RBF - Day Eight - Impact Evaluation Note - Pakistan

  1. 1. Impact Evaluation Note Country Dr Tayyab Massod ! Dr Akhtar Rashid H E A LTH R ESU LTS IN NOVATION TRUS T FU N D
  2. 2. 1.  Background •  Punjab’s health outcomes have improved but the pace of change remains slow. •  Punjab’s under-five and infant mortality (MDG 5) at 104 and 82 deaths per 1000 live births in 2011. •  Immunization coverage is suboptimal - only 35% of children aged 12-23 months in Punjab are fully immunized (measles 2) •  Maternal mortality ratio (MDG 4) at 227 per 100,000 live births is lower than national average. •  Inequities persist in health outcomes and service use between the poor and non-poor and between rural and urban households •  The efficiency of resource use is low due to pervasive problems of governance and weak and centralized management. 2
  3. 3. 1.  Background •  GoP has approved a health sector strategy •  The Bank and DFID are supporting this with a $285m investment •  HRITF grant will be used to test a few pertinent innovations outlined in the strategy 3
  4. 4. 2. Description of Intervention •  Facility Based Performance Incentives: o  To enhance performance and improvements in quality of services at facility level o  Facilities will be contracted with specific outputs/ indicators related to primary health care and incentive will be utilized for individuals as well as recurrent costs •  Demand side voucher for safe delivery : o  Improve institutional delivery and maternal survival targeted on income level o  Voucher will cover ANC, PNC and institutional delivery o  Cash incentive to the beneficiary and pre-determined cost for institutional delivery to be paid to the health facility (includes public and private). •  Performance based district management contracts : o  To strengthen performance based management at the district level o  Provide performance rewards to good performing districts o  Improving quality of care through better planning, monitoring and supervision 4
  5. 5. 3. Results Chain o  Cash Transfers to facilities… INPUTS ACTIVITIES OUTPUTS OUTCOMES LONGER-TERM OUTCOMES HIGHER ORDER GOALS o  Signing of Contracts: o  Supervision & Monitoring o  Provision of identified Services. o  Improvement in Preventive Health Indicators… o  Decreased mother and child mortality o  Signing of Contracts: o  Quarterly evaluations/ meetings o  Improvement in Preventive Health Indicators… o  Decreased mother and child mortality 1. Facility based performance contracts 2. Performance Based District Management Contracts Verification of Results o Improvement in delivery of Essential Package of Health Services, including integrated MNCH/FP, nutrition, and control of communicable disease o  Improved Supervision and M&R budgets o  Performance incentives to managers Verification of Results
  6. 6. 3. Results Chain o  Awareness of services, o  Incentive to provider and consumer INPUTS ACTIVITIES OUTPUTS OUTCOMES LONGER-TERM OUTCOMES HIGHER ORDER GOALS o Identification of Beneficiaries o Voucher Distribution o  2+ ANC, Institutional Delivery, PNC o  Decrease maternal morbidity o  Decreased mother and child mortality 3. Demand Side Incentives for Safe Delivery (Voucher Scheme) Verification of Results
  7. 7. 4. Primary Research Questions •  Can RBF approaches increase the level of health service utilization leading to better health outcomes in Punjab o  Which approach will have more effect? o  What is the cost? •  Comparison between Five Approaches o  Outsourcing Primary Care Services (PRSP) o  Performance based district management contracts o  Facility based performance contracts o  Demand side Incentives for safe delivery (vouchers o  Health Protection/ Insurance for the Poor 7
  8. 8. 5. Outcome Indicators •  District Management Contracts o  performance indicators related to delivery of essential package of health care, integrated Maternal Neonatal and Child Health program and communicable disease control •  Facility contracts o  Maternal Neonatal and Child Health program, nutrition, immunization, family planning and general management. •  Safe Delivery Voucher o  At least 2 Antenatal Care Visits, Delivery by SBA at Health Facility, Post Natal Care 8
  9. 9. 6. Identification Strategy/ Method •  Multiple Research methods include o  Data collection will be on a prospective basis, from Community, Facilities and management •  Statistical Techniques to be used will be: o  Difference in Difference to assess quantitative effect o  Discontinuity Regression to statistically control and validate the Diff in Diff results o  Ongoing qualitative work: including a political economy study o  Process evaluations will inform implementation 9
  10. 10. 7. Sample and Data •  The Universe is the worse off 18 out of 36 Districts in Punjab •  The data collection will be done in six districts o  Two for vouchers o  Two for facility contracts o  Two for health protection/ insurance •  Qualitative : In depth Interviews with managers, community beneficiaries, health facility staff •  Quantitative: Health Diaries at Household level, Community surveys, exit interviews, health facility assessment, management reviews 10
  11. 11. 8. Time Frame / Work Plan •  Ac#vity   TimeLine •  Project  team  on  board   June 2014 •  I.E  team     June 2014 •  Comple4on  of  contrac4ng  process  for  :   •  (IE  data  collec4on  firm,  University,  VMA,  Health   Facili4es,  District  Management  contracts,  External   Verifica4on  Firm)   December 2014 •  Iden4fica4on  of  beneficiaries  for  vouchers   December 2014 •  Vouchers  distribu4on     March 2015 •           Midline  Evalua4on   March 2016 •  Expansion  of  facility  contracts   June 2016 •  End  line  evalua4on   March 2018 11

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