Annual Results and Impact Evaluation Workshop for RBF - Day Eight - Impact Evaluation Note - Armenia
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)
â˘âŻ Nation-wide RBF in PHC since 2011
â˘âŻ Government-funded, covering 350 PHC facilities
â˘âŻ RBF on top of capitation payment mechanism
â˘âŻ Started with 10 performance indicators (2011)
â˘âŻ Increased to 30 indicators in 2012
â˘âŻ Each visit to PHC provider is registered with special
form, then entered into electronic HIM system
â˘âŻ Electronic reports are presented to State Health
Agency of MoH on a monthly basis, and are
summarized annually for payment
2
3. Background (2)
â˘âŻ Payment frequency â annual (second quarter of
next year)
â˘âŻ Bonus payments amount to 5 to 7 percent of
providersâ annual income
â˘âŻ 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).
3
4. 2. Description of Intervention
From July 2014, WB will pool $ with GoA to
Nation-wide
â˘âŻ Add 3 more indicators for screening of diseases
(cervical cancer, diabetes, hypertension)
â˘âŻ Increase size & frequency of incentives
â˘âŻ Strengthen verification of results
For a sub-set of facilities
â˘âŻ Test different supplementary interventions to
enhance RBF scheme
4
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?
6
7. 5. Outcome Indicators
For the first research question:
â˘âŻ Indicators related to coverage of MCH and
NCD interventions under RBF scheme
For the last two research questions:
â˘âŻ Focus on indicators related to quality of care
(clinical processes) related to MCH and NCD
â˘âŻ We will also consider possible health
outcome indicators
7
8. 6. Identification Strategy/ Method
1. First research question: before-and-after ď
2. Last two questions: Randomized Controlled
Trial ď
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
8
9. 7. Data source
â˘âŻ Household surveys
â˘âŻ Facility surveys
â˘âŻ Provider surveys (including direct
observation, chart review)
â˘âŻ Routine HMIS data
â˘âŻ Qualitative data from IDI and FGD
9
10. 8. Time Frame / Work Plan
â˘âŻ Baseline survey for question 1 (before and
after): 2012 HHS, facility and provider surveys
â˘âŻ Concept note: May 2014
â˘âŻ Baseline for questions 2 and 3: facility and
provider surveys in September 2014
â˘âŻ Implementation of interventions for 60 health
facilities:
Jan 2015-Dec 2016
â˘âŻ End-line surveys: Jan 2017
10