Clinical trial NCT03890653: Impact Evaluation of the Nigeria Result-Based Financing Project
Official title: Impact Evaluation of the Nigeria State Health Program Investment Credit (NSHPIC)
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Maternal Care Patterns
Lead sponsor: World Bank
Sponsor class: OTHER
First posted: 2019-03-26
Enrollment: 74
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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. 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. 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. 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.

The evaluation of the PBF arm, which consists of making payments to health facilities conditional on performance, but within an environment of comparable levels of overall financing, will rely on experimental assignment. The effect of the PBF intervention will be identified by comparing outcomes in the LGAs receiving PBF versus those receiving DFF in the three project states. In each of these three States, the LGAs will be randomly assigned to either the PBF package or to the DFF package.

Detailed description: A detailed description can be found in the attached project concept note.

Eligibility criteria: Inclusion Criteria:

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

Exclusion Criteria:

1. None.

Primary outcomes:
measure: Utilization of priority maternal and child health services
timeFrame: Each health facility assessed over a period of two days.
Secondary outcomes:
measure: Utilization of priority maternal and child health services, particularly by the poor
timeFrame: Each health facility assessed over a period of two days.
measure: Aggregated Provider Performance through Direct Clinical Observation
timeFrame: Each health provider assessed over a period of one day.
measure: Aggregate Structural and Process Quality Index
timeFrame: Each health facility assessed over a period of two days.
Other outcomes:
Locations:
Study officials:
affiliation: World Bank
name: Eeshani Kandpal, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.