Impact Evaluation of the Nigeria Result-Based Financing Project

NCT03890653 | Unknown

• 1 other identifier: P128175
• Study Type: interventional
• Target: 74
• Locations: 0 countries
• Sites: N/A

Brief 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. 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. 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. 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.

Conditions

Maternal Care Patterns

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (3)

• Utilization of priority maternal and child health services, particularly by the poor

  Each health facility assessed over a period of two days.

• Aggregated Provider Performance through Direct Clinical Observation

  Each health provider assessed over a period of one day.

• Aggregate Structural and Process Quality Index

  Each health facility assessed over a period of two days.

Study Arms (3)

Performance-Based Financing

EXPERIMENTAL

At least one primary healthcare centre per ward and one General Hospital per selected LGA (in 50% of LGAs in each of the 3 states) and one secondary hospital per State will be contracted by the State Primary Health Care Development Agency ) , to deliver specified services at an agreed price. Selection of which services to focus on is based on priorities identified by the Federal Government of Nigeria and the states in 2010-2015. Initial prices for each service were based on shadow prices of providing the service and have been adjusted based on implementation experience.

Behavioral: Performance-Based Financing

Decentralized Facility Financing

EXPERIMENTAL

In the other half of the LGA's in each treated state, at least 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.

Behavioral: Decentralized Facility Financing

Control

NO INTERVENTION

This is a pure control arm with no additional interventions.

Interventions

Performance-Based Financing BEHAVIORAL

Incentive-based payments

Performance-Based Financing

Decentralized Facility Financing BEHAVIORAL

Financing not linked to service delivery.

Decentralized Facility Financing

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• All health facility staff in the states of Nasarawa, Adamawa and Ondo attending to maternity patients in the study period.
• Selected mothers recently utilizing the same facilities if consent is provided.

You may not qualify if:

• \. None.

Sponsors & Collaborators

• World Bank: lead

Related Publications (1)

• Khanna M, Loevinsohn B, Pradhan E, Fadeyibi O, McGee K, Odutolu O, Fritsche GB, Meribole E, Vermeersch CMJ, Kandpal E. Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria. BMC Med. 2021 Sep 21;19(1):224. doi: 10.1186/s12916-021-02092-4.

  PMID: 34544415 DERIVED

Study Officials

• Eeshani Kandpal, PhD

  World Bank

  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: May 8, 2017
• First Posted: March 26, 2019
• Study Start: August 20, 2013
• Primary Completion: September 30, 2017
• Study Completion: December 15, 2019
• Last Updated: March 26, 2019

Record last verified: 2019-03

Data Sharing

• IPD Sharing: Will not share