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

1. Impact Evaluation Note
ARMENIA
GOA: Saro Tsaturyan, Yervand Elibekyan, !
Task team: Wezi Msisha, Susanna Hayrapetyan!
IE team: Son-Nam Nguyen, Kent Ranson
H E A LTH R ESU LTS IN NOVATION TRUS T FU N D

2. Background (1)
• Nation-wide RBF in PHC since 2011
• Government-funded, covering 350 PHC facilities
• RBF on top of capitation payment mechanism
• Started with 10 performance indicators (2011)
• Increased to 30 indicators in 2012
• Each visit to PHC provider is registered with special
form, then entered into electronic HIM system
• Electronic reports are presented to State Health
Agency of MoH on a monthly basis, and are
summarized annually for payment
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3. Background (2)
• Payment frequency – annual (second quarter of
next year)
• Bonus payments amount to 5 to 7 percent of
providers’ annual income
• Indicators cover:
o Disease prevention (6 indicators)
o Control of chronic diseases (7 indicators)
o Maternal and Reproductive Health (3 indicators)
o Child Care (7 indicators)
o TB detection (1 indicator)
o Maintaining Electronic Registers of Patients with certain Diseases (6
indicators).
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4. 2. Description of Intervention
From July 2014, WB will pool $ with GoA to
Nation-wide
• Add 3 more indicators for screening of diseases
(cervical cancer, diabetes, hypertension)
• Increase size & frequency of incentives
• Strengthen verification of results
For a sub-set of facilities
• Test different supplementary interventions to
enhance RBF scheme
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5. Description of Intervention (2)
Interventions for a subset of health
facilities
- Quarterly supportive QoC
supervision by MOH to 30 facilities
- Quarterly clinical vignettes
administered to PHC providers in
30 facilities and feedbacks

6. 4. Primary Research Questions
For the nation-wide RBF:
1. Does the RBF improve providers
performance related to the new indicators?
For a subset of facilities
2. Does regular QoC supportive supervision
improve quality of care under RBF scheme?
3. Do regular vignettes and feedbacks
improve quality of care under RBF scheme?
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7. 5. Outcome Indicators
For the first research question:
• Indicators related to coverage of MCH and
NCD interventions under RBF scheme
For the last two research questions:
• Focus on indicators related to quality of care
(clinical processes) related to MCH and NCD
• We will also consider possible health
outcome indicators
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8. 6. Identification Strategy/ Method
1. First research question: before-and-after 
2. Last two questions: Randomized Controlled
Trial 
90 PHC facilities will be randomly selected and
assigned into 3 arms:
- Arm 1: QoC supportive supervision visit
- Arm 2: Regular clinical vignettes and feedbacks
to providers
- Arm 3: Control
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9. 7. Data source
• Household surveys
• Facility surveys
• Provider surveys (including direct
observation, chart review)
• Routine HMIS data
• Qualitative data from IDI and FGD
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10. 8. Time Frame / Work Plan
• Baseline survey for question 1 (before and
after): 2012 HHS, facility and provider surveys
• Concept note: May 2014
• Baseline for questions 2 and 3: facility and
provider surveys in September 2014
• Implementation of interventions for 60 health
facilities:
Jan 2015-Dec 2016
• End-line surveys: Jan 2017
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