Measuring and Understanding the Effects of a Performance Based Financing Scheme Applied to Nutrition Services in Burundi

NCT02721160 | Completed

• 1 other identifier: IRB-951/14
• Study Type: interventional
• Target: 90
• Locations: 0 countries
• Sites: N/A

Brief Summary

The government of Burundi is implementing a new financing scheme in health centres. The objective is to provide additional financial compensations to health centres on the basis of their performance in nutrition activities: it consists in the introduction of criteria focusing on malnutrition prevention and care activities in the existing performance based financing (PBF) system. The general objective of this study is to assess the effects of this new financing scheme, to document its impact and to study the chains through which it occurred. This study will provide key evidence for countries with an existing PBF scheme and confronted with malnutrition problems on the appropriateness to extend the strategy to nutrition services. If this impact evaluation brings positive results, this may have implications for the global fight against malnutrition.

Conditions

Malnutrition

Keywords

performance-based financing; malnutrition; impact evaluation

Outcome Measures

Primary Outcomes (2)

• Change in recovery rate of acute malnutrition in children below five years old over two years

  Recovery rate of acute malnutrition in children below five years old is assessed through clinical files of acute malnutrition cases completed during the six-month periods preceding each survey (first wave: clinical files cover the March-August 2014 period; second wave: it covers the May-October 2016 period).

  26 months from baseline; endline survey in December 2016

• Difference in prevalence of acute malnutrition among children aged 6-23 months between Dec 2014 and Dec 2016

  Acute malnutrition is defined as: weight for height z-score\<-2 or mid-upper arm circumference\<125 mm

  Two years from baseline; endline survey in December 2016

Secondary Outcomes (2)

• Difference in prevalence of stunting among children aged 6-23 months between Dec 2014 and Dec 2016

  Two years from baseline; endline survey in December 2016

• Difference in weight-for-Height Z-score among children aged 6-23 months between Dec 2014 and Dec 2016

  Two years from baseline; endline survey in December 2016

Study Arms (2)

Nutrition PBF

EXPERIMENTAL

45 health centres are assigned to this group. The intervention consists in a performance based financing scheme applied to nutrition services.

Other: Nutrition PBF

Control

NO INTERVENTION

45 health centres are in the control group. Health centres in this group are not incentivized, but they receive an equivalent funding to the one received by the intervention group. The main difference is that this payment is not based on their own performance.

Interventions

Nutrition PBF OTHER

Nutrition PBF focuses on children under five years old. It follows the standard PBF model in Burundi and combines quantitative indicators to encourage an increase in service delivery (see Table below) and qualitative indicators. Quality of nutrition activities is assessed quarterly, and a bonus or penalty is applied to subsidies received by the facilities according to their quality score. Table: Incentivized indicators CHW level * nb of cases screened and referred to HC for acute malnutrition (AM) * nb of classes promoting good nutrition HC level * nb of cases screened and cared for severe and moderate AM * nb of growth follow-ups Hospital level * nb of treated severe AM cases with complications * length of the stay All hospitals with nutrition services fall under the Nutrition PBF program. At lower levels, only HCs in the intervention group and the CHW that refer to them are subject to the Nutrition PBF.

Nutrition PBF

Eligibility Criteria

• Age: 6 Months - 23 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Living in the catchment area of a health center under the study

You may not qualify if:

• Mother or tutor of the child not available for the survey
• Head of household or husband of the mother of the child not available for the survey

Sponsors & Collaborators

• Institute of Tropical Medicine, Belgium: lead
• World Bank: collaborator
• Ministry of Health, Burundi: collaborator
• Institut de Statistiques, Burundi (ISTEEBU): collaborator
• Institut National de Santé Publique, Burundi (INSP): collaborator

Related Publications (7)

• Basinga P, Mayaka S, Condo J. Performance-based financing: the need for more research. Bull World Health Organ. 2011 Sep 1;89(9):698-9. doi: 10.2471/BLT.11.089912. No abstract available.

  PMID: 21897492 BACKGROUND

• Institut de Statistiques et d'Études Économiques du Burundi (ISTEEBU), Ministère de la Santé Publique et de la Lutte contre le Sida [Burundi] (MSPLS), and ICF International. 2012. Enquête Démographique et de Santé Burundi 2010 (DHS Burundi 2010, Final Report). Bujumbura, Burundi : ISTEEBU, MSPLS, et ICF International.

  BACKGROUND

• Kaiser R, Woodruff BA, Bilukha O, Spiegel PB, Salama P. Using design effects from previous cluster surveys to guide sample size calculation in emergency settings. Disasters. 2006 Jun;30(2):199-211. doi: 10.1111/j.0361-3666.2006.00315.x.

  PMID: 16689918 BACKGROUND

• Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999 Apr;28(2):319-26. doi: 10.1093/ije/28.2.319.

  PMID: 10342698 BACKGROUND

• Nimpagaritse M, Korachais C, Nsengiyumva G, Macq J, Meessen B. Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi? BMC Nutr. 2019 Mar 5;5:22. doi: 10.1186/s40795-019-0282-y. eCollection 2019.

  PMID: 32153935 DERIVED

• Nimpagaritse M, Korachais C, Meessen B. Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi. PLoS One. 2020 Jan 13;15(1):e0226376. doi: 10.1371/journal.pone.0226376. eCollection 2020.

  PMID: 31929554 DERIVED

• Nimpagaritse M, Korachais C, Roberfroid D, Kolsteren P, Zine Eddine El Idrissi MD, Meessen B. Measuring and understanding the effects of a performance based financing scheme applied to nutrition services in Burundi-a mixed method impact evaluation design. Int J Equity Health. 2016 Jun 14;15:93. doi: 10.1186/s12939-016-0382-0.

  PMID: 27301741 DERIVED

MeSH Terms

Conditions

Malnutrition

Condition Hierarchy (Ancestors)

Nutrition Disorders; Nutritional and Metabolic Diseases

Study Officials

• Catherine Korachais, PhD

  Institute of Tropical Medicine of Antwerp, Belgium

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 1, 2016
• First Posted: March 29, 2016
• Study Start: December 1, 2014
• Primary Completion: April 1, 2017
• Study Completion: May 1, 2018
• Last Updated: June 1, 2018

Record last verified: 2017-03

Data Sharing

• IPD Sharing: Will share