Impact Evaluation of the Nigeria Result-Based Financing Project

Maternal Care Patterns Clinical Trial

Official title:

Impact Evaluation of the Nigeria State Health Program Investment Credit (NSHPIC)

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03890653
• Other study ID #: P128175
• Status: Active, not recruiting
• Phase: N/A
• Start date: August 20, 2013
• Est. completion date: December 15, 2019

Study information

• Verified date: March 2019
• Source: World Bank
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The World Bank and the government of Nigeria are implementing a results-based financing (RBF) project for the states of Nasarawa, Adamawa, and Ondo. This project provides incentives for improving performance at critical levels within the Nigerian health system and aims to address some of these challenges. The primary goal of the impact evaluation of this project is to determine if providing financial incentives linked directly to performance increases the quantity and quality of maternal and child health (MCH) services.

In each of the three selected States,the project finances the following interventions:

1. Performance incentives to State Government and Local Government (LGA) agencies that are triggered by Disbursement Linked Indicators (DLIs) that reflect strengthened supervision and enhanced operational support for improving health systems performance. These performance incentives would be paid out on an annual basis.

2. In half of the LGAs in each state, one facility per ward will receive Performance-Based Financing (PBF) wherein payments are made directly to individual health facilities based on the quantity and quality of a set of pre-defined services provided by each facility. These performance incentives would be paid out on a quarterly basis.

3. In the other half of the LGAs in each state one facility per ward will receive Decentralized Facility Financing (DFF) or equivalent financing that is not be linked to any service delivery targets. These payments would be made on a quarterly basis.

The evaluation of the PBF arm, which consists of making payments to health facilities conditional on performance, but within an environment of comparable levels of overall financing, will rely on experimental assignment. The effect of the PBF intervention will be identified by comparing outcomes in the LGAs receiving PBF versus those receiving DFF in the three project states. In each of these three States, the LGAs will be randomly assigned to either the PBF package or to the DFF package.

Description:

A detailed description can be found in the attached project concept note.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 74
• Est. completion date: December 15, 2019
• Est. primary completion date: September 30, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

1. All health facility staff in the states of Nasarawa, Adamawa and Ondo attending to maternity patients in the study period.

2. Selected mothers recently utilizing the same facilities if consent is provided.

Exclusion Criteria:

1. None.

Related Conditions & MeSH terms

• Maternal Care Patterns

Intervention

Behavioral:
• Performance-Based Financing
Incentive-based payments
• Decentralized Facility Financing
Financing not linked to service delivery.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
World Bank

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Utilization of priority maternal and child health services	The utilization of priority MCH services, as defined by the quantitative checklist used by the project to measure and reward facility performance.	Each health facility assessed over a period of two days.
Secondary	Utilization of priority maternal and child health services, particularly by the poor	The utilization of priority MCH services, as defined by the quantitative checklist used by the project to measure and reward facility performance, by poor households.	Each health facility assessed over a period of two days.
Secondary	Aggregated Provider Performance through Direct Clinical Observation	We use data on direct clinical observations of labor and delivery to construct an aggregate measure of provider performance.	Each health provider assessed over a period of one day.
Secondary	Aggregate Structural and Process Quality Index	The quantitative checklist used in the government program is replicated to a large degree in the impact evaluation survey. We construct independent observations on aggregate structural and process quality measures in the same fashion as the program has constructed and rewarded.	Each health facility assessed over a period of two days.