Impact Evaluation Note ARMENIA

GOA: Saro Tsaturyan, Yervand Elibekyan, !Task team: Wezi Msisha, Susanna Hayrapetyan!IE team: Son-Nam Nguyen, Kent Ranson

H E A LT H R E S U LT S I N N O VAT I O N T R U S T F U N D

Background (1)

•  Nation-wide RBF in PHC since 2011 •  Government-funded, covering 350 PHC facilities •  RBF on top of capitation payment mechanism •  Started with 10 performance indicators (2011) •  Increased to 30 indicators in 2012 •  Each visit to PHC provider is registered with special

form, then entered into electronic HIM system •  Electronic reports are presented to State Health

Agency of MoH on a monthly basis, and are summarized annually for payment

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Background (2)

•  Payment frequency – annual (second quarter of next year)

•  Bonus payments amount to 5 to 7 percent of providers’ annual income

•  Indicators cover: o  Disease prevention (6 indicators) o  Control of chronic diseases (7 indicators) o  Maternal and Reproductive Health (3 indicators) o  Child Care (7 indicators) o  TB detection (1 indicator) o  Maintaining Electronic Registers of Patients with certain Diseases (6

indicators).

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2. Description of Intervention

From July 2014, WB will pool $ with GoA to Nation-wide •  Add 3 more indicators for screening of diseases

(cervical cancer, diabetes, hypertension) •  Increase size & frequency of incentives •  Strengthen verification of results For a sub-set of facilities •  Test different supplementary interventions to

enhance RBF scheme

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Description of Intervention (2) Interventions for a subset of health facilities -  Quarterly supportive QoC

supervision by MOH to 30 facilities -  Quarterly clinical vignettes

administered to PHC providers in 30 facilities and feedbacks

4. Primary Research Questions

For the nation-wide RBF: 1. Does the RBF improve providers performance related to the new indicators? For a subset of facilities 2. Does regular QoC supportive supervision improve quality of care under RBF scheme? 3. Do regular vignettes and feedbacks improve quality of care under RBF scheme?

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5. Outcome Indicators

For the first research question: •  Indicators related to coverage of MCH and

NCD interventions under RBF scheme For the last two research questions: •  Focus on indicators related to quality of care

(clinical processes) related to MCH and NCD •  We will also consider possible health

outcome indicators

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6. Identification Strategy/ Method

1. First research question: before-and-after 2. Last two questions: Randomized Controlled Trial 90 PHC facilities will be randomly selected and assigned into 3 arms: -  Arm 1: QoC supportive supervision visit -  Arm 2: Regular clinical vignettes and feedbacks

to providers -  Arm 3: Control

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7. Data source

• Household surveys •  Facility surveys •  Provider surveys (including direct

observation, chart review) •  Routine HMIS data • Qualitative data from IDI and FGD

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8. Time Frame / Work Plan

•  Baseline survey for question 1 (before and after): 2012 HHS, facility and provider surveys

•  Concept note: May 2014 •  Baseline for questions 2 and 3: facility and

provider surveys in September 2014 •  Implementation of interventions for 60 health

facilities: Jan 2015-Dec 2016

•  End-line surveys: Jan 2017

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