A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

1. Impact Evaluation Note
Lesotho
Mamoruti Theli and Leutsoa Matsoso
H E A LTH R ESU LTS IN NOVATION TRUS T FU N D

2. Background
• Small landlocked country, 1.9m
• Mountainous terrain
• High maternal (1,155/100,000 births) and under-five
mortality (86/1,000 births)
• 3rd highest HIV prevalence (23.2%)
• Two main service providers (Public and CHAL)
• 10 districts (capital district excluded from PBF)
2

3. Description of Intervention
• Improving MNH services via incentive payments
o Health centers together with VHWs (quantity, quality and
remoteness)
o District hospitals (quantity, and quality)
o DHMTs for supervision
• 3 phases
o Phase 1 ( 2 districts, not part of impact evaluation)
o Phase 2 (additional 4 districts, 1 year after Phase 1)
o Phase 3 (additional 3 districts, 2 years after phase 1)
3

4. Primary Research Questions
• What is the causal effect of the PBF program on
o quantity of MNH services
o quality of MNH services
o health outcomes ?
• What is the cost-effectiveness of PBF vs. additional health
financing not tied to performance?
• Does the PBF program reduce inequity?
4

5. Outcome Indicators
• % institutional deliveries
• % fully immunized
• % women using modern contraceptives
• Quality of care score
• Weight-for-age, height-for-age
• Prevalence of anemia
5

6. Randomized phase-in design
Full PBF package:
 Linking payments and
results
 Managerial autonomy
within defined limits
 Systematic supervision
Additional Resources:
 Not tied to performance
 Equaling average
resources of treatment
 Follow existing guidelines
about use of funds
 Switch to PBF when study
ends!
Treatment Control
Health centers will be randomized into 2 study groups:

7. Sample
Households with women
of childbearing age
Health
Centers
Study Arms
PBF IE
Treatment
1 2 … 44
1 2 …
…
25
0
Control
1 2 … 44
Total: 88 health centers, up to 2,200 households

8. Data: Household Surveys
Sample:
• Households in catchment areas served by the control and
treatment facilities
• The selected household will have a woman with a recent
pregnancy
Survey components:
• Household roster and socioeconomic status
• Utilization and health behaviors regarding MNH services
• Household health expenditure
• Perceptions of health service quality
• Anthropometry and biomarker: and anemia

9. Timeline
Phase
2
districts
Phase
3
districts
Treatment
Control
Treatment
Control
Implementa)on
Survey
Implementa)on
Survey
Implementa)on
Survey
Implementa)on
Survey
2015
Q1
Baseline
Baseline
Q2
Q3
Full
PBF
Addi;onal
Financing
Q4
2016
Q1
Baseline
Baseline
Q2
Q3
Full
PBF
Addi;onal
Financing
Q4
2017
Q2
Q3
Q4
Q1
2017
Q2
Endline
Endline
Q3
Endline
Endline
Q3
Full
PBF
Full
PBF
Q4