Cameroon PBF Impact

Evaluation

Midline Qualitative Study Protocol

Jake Robyn| Health Specialist

HSSIP project zones

Impact evaluation design

• PBF Impact Evaluation: 14 health districts where PBF has not yet been piloted as of August 2011 o Data: Household and health facility surveys

o Sample: 250 facilities and 4000 households

o Baseline survey completed in June 2012

• Research questions 1. Does the PBF program increase the coverage and of MCH

services?

2. Is it the enhanced monitoring & evaluation and supervision or the link between payments and results that leads to improvements observed in quality or coverage?

3. What is the contribution of enhanced supervision and monitoring to improving MCH service coverage and quality in the absence of increased autonomy or additional financial resources?

4. What is the cost-effectiveness of PBF in terms of improvements achieved per dollar?

Impact Evaluation study groups

T1: PBF with health

worker performance

bonuses

C2: No additional

resources but same

supervision and monitoring

as PBF arms T 1 and C1

C3: Status quo

C1: Same per capita

financial resources as PBF

but not linked to

performance; Supervision,

monitoring and managerial

autonomy as T1

60 Health Facilities 57 Health Facilities

56 Health Facilities 60 Health Facilities

Impact evaluation timeline

Concept Note

Finalize Program and IE Design

IE Baseline

Implement RBF

IE Endline

Analysis and

Dissemination

IE Qualitative

midline

2011 2012 2013 2014 2015

Cameroon midline qualitative study

• The Cameroon midline qualitative study focuses on two

primary themes:

o Experiences in the piloting of PBF at the central, regional and district level:

perspectives of decision-makers and policymakers

o Experiential elements of health service delivery at the operational level:

perspectives of patients and providers

Sampled stakeholders

• Purposive Sampling in all 4 Regions:

o Northwest

o Southwest

o East (IE districts only)

o Littoral

Interview guides for each target group

• Policymakers, administrative leaders and development

partners o What have been the challenges, bottlenecks and successes during the

preparation of the pilot and first year of implementation?

• Operational level o How have PBF implementers at the operational level, such as Performance

Purchasing Agencies and district health management teams, experienced PBF

during the first year of operations?

• Service delivery level (T1, C1, C2, C3) o How have providers’ experiences with quality of care changed since the

introduction of PBF?

o How have community members and patients experiences with quality of care

changed since the introduction of PBF?

o How have community leaders and community health workers experiences with

quality of care changed since the introduction of PBF?

o

• Data Transcription: Hire an independent transcription

firm

Data Collection • 136 total interviews

• 120 In-Depth Interviews (IDIs)

• One-on-one key informant interviews

• 16 Focus Group Discussions (FGDs) • Community-focused

• Captures complex ideas in-depth

• Captures a variety of views and opinions

Sampling Methodology PBF in Cameroun: Mid-line Qualitative Study Interview Format Total IDIs Total FGDs

Proposed Sampling and # of IDIs and FGDs IDIs FGDs

Central Level

Ministry of Health 2 x 2

Development Partners 2 x 2

Regional Level (4 TOTAL Regions: NW, SW, Littoral, and East)

Regional Health Delegates 1 x 4

District Medical Officers 2* x 8

IE Study Groups (T1, C1, C2 and C3)

District Hospitals and Primary Health Centres (Directors and Administrators) 18** x 72

Community Level

Community Leaders 2*** x 32 x

Community Members, Health Workers, etc. x 4/region*** 16

* 2 DMOs per region

**Stratifed by IE Study Group; 18 total IDIs per region

***Following FGD catchment (2 per village/4 villages total/8 per region) GRAND TOTALS for Midline Qualitative Study

****Stratifed by T1/C3 IE Study Groups; Urban/Rural; Female only IDIs 120

FGs 16

136 interviews TOTAL

Health facility sampling

o IDI Sampling - Health Facility Level (18 per region, 72 total)

• The sample of district hospitals and primary care health facilities will be

sampled per IE study group.

T1 C1 C2 C3

Urban Rural Urban Rural Urban Rural Urban Rural

Public 1 1 1 1 1 1 1 0

Confessional 1 1 1 1 0 1 1 1

Private 1 1 0 0 1 0 0 1

Total 6 4 4 4

Community IDI sampling

• IDI Sampling – Community Level (32)

• Key Informants o Women’s Group Leader

o Community Member of Health Centre Committee

T1 C3

Urban Rural Urban Rural

Women’s Group Leader 1 1 1 1

Community Member of

HCC 1 1 1 1

8 per region, and 32 countrywide

Focus group dicsussions • Focus Group Discussions Sampling and Distribution:

o T1/C3 Catchment Areas

o Urban/Rural Stratification

o Female Only (MCH)

• FGDs Themes: • Health-seeking behaviors

• Current Experience with Health Facilities

• Improvements and Looking Ahead

T1 C2 Urban Rural Urban Rural Female Female Female Female

1 1 1 1

4 per region, and 16 countrywide

Data analysis and writing • Coding

o NVivo 10 qualitative analysis software

• The qualitative study core team will work together to ensure

reliability and validity of coding.

• The analysis process begins with data collection,

transcription, working with the data directly, and writing.

• Report will be completed and disseminated by June 2014.