facilities had very large catchment areas, resulting in a target population approximately three times higher than in the C1 group. As such the per capita payments in the South-West region were three times higher for the C1 group than the T1 group, which also affects the overall annual per capita payments (Appendix Figure A8). That being said, the overall payments for each group, when combining the three regions, shows equal payments across the two groups (Appendix Figure A9). Populations of catchment areas in Cameroon should also be interpreted with precaution given the lack of an up-to-date and comprehensive national health map.

# FACILITY SURVEY UTILIZATION RESULTS

This section describes the results of PBF on health services provision as recorded in facility registers. To assess the reliability of these data, we examined the health service counterverification data that were collected routinely as part of the PBF program design through community client satisfaction surveys. Health service verification took place in all PBF health facilities, as well as in health facilities in control groups C1 (additional financing) and C2 (additional supervision). Thirty-five patients were sampled for 7 health service categories each quarter. Figure 2 shows the percentage of patients who were reported by health facilities to the PBF verification terms, who were later confirmed to have received health services at the health facility. During most quarters of the three-year study period in all three study regions, over 80% of reported patients were confirmed. The trend in confirmed patients increased slightly over time in North-West and East, with confirmation rates above 85% in all three regions during the final year of the study. Though we find reassuringly high quality data among the treatment group health facilities, it is possible that facilities in the full control group had less incentive to keep records of all services provided. Given that we did not verify the health service data collected from the full control group, we cannot investigate this possibility. Therefore, the possibility of incomplete reporting in the full control remains a limitation of this analysis.

Table 4 displays health service utilization results as assessed in the facility survey. Facility level provision of health services in the six months before the survey took place was assessed using patient registers from study health facilities. All data were collected at the monthly level; therefore, the interaction term coefficients represent differences between groups in the change in monthly services provided. Provision of skilled delivery did not increase in the control group during the study period. Relative to the control there were no statistical differences in mean monthly provision of skilled delivery in the full PBF and the additional supervision group; however, there was a relative increase of approximately 2 monthly deliveries in the additional financing group (additional financing 1.855, p-value = 0.071). The overall change between 2012 and 2015 in antenatal care provision in study health facilities was positive, but was not statistically significant. Relative to the control group there was an increase in antenatal care in all three treatment groups; however, none of these differences were statistically significant (Table 4).

Comparing the six-months before the baseline, and the six months before the endline survey, provision of tetanus toxoid vaccine declined by a monthly average of almost 17 vaccinations in control facilities each month (Table 4, column 3). Compared to the change observed in the control group, there was a positive and statistically significant difference in the PBF and additional financing groups (PBF 21.521, p-value = 0.001; additional financing 15.989, p-value = 0.014). Compared to control facilities, facilities with additional supervision provided on average approximately nine more tetanus vaccines monthly to pregnant women, but this difference was 12