Impact Evaluation Note Tajikistan S. Sahibova, S. Barfieva, W. Msisha

H E A LT H R E S U LT S I N N O VAT I O N T R U S T F U N D

1. Background

•  Maternal and Child Health (MCH) outcomes in Tajikistan are poor o  Infant Mortality Rate: 34 per 1,000 o  Under 5 Mortality Rate: 43 per 1,000 o  Children under 5 who are stunted: 26% [DHS 2012, Report]

•  Coverage of key MCH services is low •  NCD’s are also a significant cause of morbidity and

mortality •  PHC workers are underpaid and low motivation is a concern •  PHC facility managers lack management autonomy

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2. Description of Intervention

Performance Based Financing (PBF) o  Implementation of PBF in rural health facilities in 8 districts o  PBF will cover a basic package of PHC services including MCH

services, treatment for communicable diseases and selected NCD’s

o  An additional intervention is Collaborative Quality Improvement, i.e., a facilitated quality improvement approach focused on common provider-identified objectives with performance feedback and competency training for provider quality improvement teams.

o  The second additional intervention is Citizen Report Cards, i.e., the dissemination of information on the performance of local health facilities by distributing a facility report card that benchmarks the performance of local facilities against an appropriately chosen reference.

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3. Primary Research Questions

•  What are the effects of PBF on the coverage/ quality of targeted health services?

•  What are the incremental effects of CQI and CRC on the coverage/ quality of targeted health services, relative to PBF?

•  What is the cost effectiveness of the different interventions?

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4.Outcome Indicators

PHC service coverage indicators for example are: -% of children under 13 months who have received all basic

vaccinations -% of children under five weighed and care-giver provided with

nutrition counseling and education The IE will also measure impact of quality improvement

interventions for example: -  PBF quality checklist for facilities -  Knowledge of providers -  Exit interviews

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6. Identification Strategy/ Method

•  The IE will employ both randomization and difference-in-difference approaches to identify the impact of the different combinations of interventions.

•  Qualitative methods will also be used

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8. Time Frame / Work Plan

•  A baseline survey will be implemented before the end of 2014 during the pre-pilot phase.

•  An end-line study will be conducted in 2018 after the interventions have been implemented for approximately 36 months.

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7. Sample and Data

•  Sample- 4,554 households in the 6 study groups, and 198 clusters (1 rural health center and its group of health houses)

•  Household data •  Facility data

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