than -2 standard deviations from the mean) and wasting (weight-for-age of less than -3 standard deviations from the mean). As shown in table 6, columns 5 – 7, there was no difference between the changes in prevalence of stunting, underweight, and wasting in the treatment groups and the control groups. While there was no change over time in stunting and underweight, the prevalence of wasting increased at endline compared to baseline.

# HEALTH CARE SPENDING

<mark>All household members were asked if they had been sick in the four weeks before the survey. Mothers or caregivers responded on behalf of household children. All respondents who had been sick were asked if they had</mark> gone to any health facility, health personnel or traditional healer to seek care for this illness. Respondents were then asked how much the household spent out-ofpocket for the treatment of this recent illness. Table 7 presents the results for several different types of reported spending. Neither the change in the control group on spending for official provider fees, nor the differences between the treatment groups and the control group were statistically significant (Table 7, column 1). There was an increase of approximately 2,052 CFA ($3.31) in the amount of unofficial provider fees paid in the control group between 2012 and 2015. The difference between the PBF group and the control group in the change over the study period was -2,254 CFA ($3.64), and this difference was statistically significant. Relative to the control group, unofficial payments also declined in the additional financing group and the additional supervision group; however, these differences were not statistically significant (Table 7, column 2). There was a non-significant increase of approximately 1,048.64 CFA ($1.69) in laboratory and x-ray fees over time in the control group. Compared to the control group, laboratory and x-rays fees declined by 1,473.44 CFA ($2.38), and this difference was statistically significant (p-value = 0.060) (Table 7, column 3). Finally, transportation fees did not change between 2012 and 2015 in the control group. There was a statistically significant difference between the control group, and the additional financing group with a decrease of 495.14 or $0.80 (Table 7, column 4).

Health spending was also assessed in the exit interview surveys conducted among women who had received prenatal care, and the caregivers of children under five years of age who visited the health facility for a child health consultation. Table 8 displays these results, even though reports by patients about health spending might be more reliable when given in the privacy of the household (household survey) than during exit interviews which take place in or close to the health facility compound, especially for reports about unofficial payments to providers. There were no changes over time, and no statistically significant differences between groups in unofficial provider fees, medicine fees, and total fees for antenatal care. The change in official provider fees for antenatal care was -1,025.34 CFA ($1.68) lower in the PBF group compared to the control group, and this difference was statistically significant (p-value = 0.083). Relative to the control group, the change in the additional financing group in official provider fees was 1,824.81 CFA ($2.98) higher (p-value = 0.038). Spending on official provider fees was significantly lower in the PBF groups than in the two treatment groups. Additionally, there was a statistically significant increase in the additional financing group and the additional supervision group in total fees for antenatal care. There were no changes over time, or differences between groups in any of the spending outcomes (official provider fee, unofficial provider fee, medicine fees, and total fees) for child health consultations.

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