Impact Evaluation Note Country: The Gambia Modou Cheyassin Phall, Bakary Jallow, Dr. Abdou Jammeh, Rifat Hasan, Günther Fink!

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

1.1 Background

  Project addressing both maternal and child health and nutrition

  To be implemented in 3 out of 7 health regions   Poorest health and nutrition indicators   Covers a population of about 600,000 (1/3 of the population)

1.2 Background cont…

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2.1 Description of Intervention

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•  Intervention 1 – Demand side: Community mobilization for social and behavior change o  Conditional cash transfer to communities and support groups o  Conditional cash transfer to individuals o  Social and behavior change communication

•  Intervention 2 – Supply side: Delivery of selected PHC services o  Performance-based financing with health centers o  Start up support (including selected health care waste management measures)

3. Results Chain

o  Training & capacity building

o  Medicines & medical supply

o  Incinerators o  SBCC o  Strategic

Contracting

INPUTS ACTIVITIES OUTPUTS OUTCOMES LONGER-TERM

OUTCOMES HIGHER ORDER

GOALS

o  RBF workshop o  HMIS trainings o  South-south

exchange o  Enhanced

monitoring and supervision

o  Data reporting & Verification

o  Payment mgt. o  Technical

assistance o  Implementation

of SBCC strategy (meetings, posters, radio, TV, etc

o  Increased demand for services

o  Improved quality of services

o  Increased provision of services

o  Increased utilization of services

o  …

o  Improved maternal & Child Health ( morbidity & mortality

o  Improved maternal and child nutritional status…

o  Improved knowledge of providers & communities

o  Increased motivation of providers & communities

o  Increased autonomy

o  Improved data quality & decision-making

o  Better prepared facilities (income, infrastructure, supplies, etc

o  Improved perception about health & nutrition services

o  Improved ownership

4. Primary Research Questions

•  What is the impact of supply- and/or demand-side intervention(s) on: o  First generation:

•  Maternal, child and adolescent health & nutrition outcomes? •  Quantity and quality of service utilization?

o  Second generation: •  Perceptions of seeking services? •  Motivation and satisfaction of health workers and community members? •  Out of pocket payments? Informal payments for MCH services? •  BFCI implementation? •  Facility infrastructure and village development? •  Linkage between communities & health facilities? •  Supervision by RHT and CHNs (for facilities & communities)? •  Staff availability? •  Three delays for delivery care? •  Awareness/knowledge at community level? •  Data reporting and management?

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5. Outcome Indicators

o  Service utilization and healthy behaviour adoption o  Skilled birth attendance o  Timely ANC & PNC visits o  Vitamin A supplementation & deworming coverage o  Referrals for ANC, skilled delivery, PNC and neonatal complications o  Exclusive breastfeeding and complementary feeding o  Hand washing facilities & latrines o  New OPD consultations o  Family planning o  Treatment of SAM

•  Maternal & Child Health and nutrition outcomes o  Under five mortality o  Wasting o  Stunting o  Birth spacing o  Incidence of diarrhoea

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  Randomized Phase In:   1 control & 2 interventions

  Randomized at:   Facility level, stratified by region –

2 phases, 18 months   Community level, stratified by facility

catchment area – 3 phases, 12 months

6. Identification Strategy/ Method

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Facility PBF Comparison Treatment

Com

munity R

BF

Comparison Group A

X Group C

Treatment Group B Group D

7. Sample and Data   Surveys:

  Baseline   Mid-line   End-line   Embedded process evaluations – pathways of impact

  Sample:   ~3,000 households per survey   24 health facilities

  Data:   Household surveys   Facility surveys   HMIS routine and administrative payment data   Focus group discussions – HCMC, community members (VSGs, VDCs, women, men etc)   In-depth interviews – MOHSW, NaNA, MOFEA; Regional Health Teams, Health facility staff,

village chiefs

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8. Time Frame / Work Plan

•  Preliminary Survey Timeline o  Baseline: August – September 2014 o  Mid-line: April – May 2016 o  End-line: November – December 2017 o  Ongoing process evaluation

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