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

1. Impact Evaluation Note
Tanzania
Names of team members!
Mariam Ally!
Fatuma Mganga!
Haazem Dominic!
Jed Friedman
H E A LTH R ESU LTS IN NOVATION TRUS T FU N D

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3. 1. Background
• Tanzania is one of the East African Countries with a
population of about 46Mil people. Occupying an area of
about 960 Sq KMs
• The country piloted Pay for Performance in Pwani region
with a population of about 1.5m (2011) funded by Norway
• 289 health facilities were enrolled in the pilot
• The pilot showed a positive impact on service coverage i.e
institutional deliveries, Child immunization etc.
• Following the pilot result, the country has decided to scale
up the scheme national wide.
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4. 2. Description of Intervention
• Introducing supply side Result based financing to the
primary health facilities and district hospitals in all regions
in phases
• Purchaser will be PMORALG, Payer – MOF. Internal
verification by IVT, Regulator will be MOHSW, External
verifier IAG
• The facilities will be paid for each service they provide on
the agreed indicators (Fee for service) with adjustment for
quality
• The focus of the RBF will be system wide approach, covering
RCH, HIV, Malaria, TB, NCD etc.
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5. 3. Results Chain
o Increased
financing to
RBF regions
o Technical
assistance
INPUTS ACTIVITIES OUTPUTS OUTCOMES
LONGER-TERM
OUTCOMES
HIGHER ORDER
GOALS
o Assessment
s from
quality team
o Payments d
processed to
facilities
according to
stated
services
delivered
o Training…
o Increased
financing of
facility
through RBF
framework
o Increased
rates of
monitoring
and
supervision
o Increased
completenes
and
timeliness of
data
reporting and
analysis…
o Increased
facility
deliveries
o Increased
rates of fully
immunized
children
o Increased
rates of
contraceptiv
e use…
o Reduced
infant and
maternal
mortality
o Reduced
TFR
o Reduced
prevalence
of
communicabl
e diseases

6. 4. Primary Research Questions
Core questions
1. In the regions with RBF, what are the causal effects of the
program on priority health outcomes.
2. What is the impact of Integrating comprehensive health services
on operational efficiency of the facility level
Operational questions
3. What is the effect of paying the facility incentives via Councils
compared to direct payment
4. What is the effect of the RBF remote bonus on facility
performance and staff retention
5. What is the difference between using NHIF as a purchaser as
compared to PMORALG - Regional Level
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7. 5. Outcome Indicators
• Priority health outcomes: number of children under one
year fully immunized, Number of under five receiving Vit A
supplements , Increase new clients enrolled on modern
temporary FP methods, number of institutional deliveries ,
number of confirmed malaria cases using MRDT/
Microscopy, number of pregnant woman attending ANC at
least 4 times during pregnancy, etc.
• System performance measures: timely receipt and
completeness of payment to facility, staff satisfaction and
retention, autonomy in facility
• Efficiency and cost of purchaser contracting
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8. 6. Identification Strategy/ Method
• Different methods will be utilized depending on question
• Questions 1 and 2 will take advantage of the phased
national roll-out of the RBF across the 25 regions (3 regions
in phase II, 8 regions in phase III, etc.) and adopt a Dif-n-Dif
framework (perhaps supplemented by matching)
• Question 3 will be answered by a district level Randomized
Control Trial
• Question 4 will scrutinize the remoteness definition to
identify facilities on either side of the remoteness
designation and utilize an RD design
• Question 5 will be answered through operational and
qualitative research as it is implemented at the regional
level
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9. 7. Sample and Data
• Dedicated baseline and end line primary data: household
and community survey, facility and HW interview, quality
measures such as direct observation will be explored
• Administrative data: HMIS and RBF operational data for
real-time monitoring across treatment and comparison
• Qualitative follow-ups after initial quantitative analysis to
further explore salient findings
• Sample sizes to be determined during next country visit
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10. 8. Time Frame / Work Plan
• To be done in 2nd phase which is expected to be from Jan.
2015
• Detailed work plan to be done later
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