Results-Based Financing Impact Evaluation 2015

Health Facility Endline Survey

Facility-based survey
The facility survey was conducted in all the CMAs, CSIs and District Hospitals in the 14 districts included in the impact evaluation. All facility team visits were unannounced. The facility-based survey included multiple components. The sample of health workers, patient-provider observations and client exit interviews was selected to enable findings from these three components to be linked.

Facility assessment module
The facility assessment module collected data on key aspects of facility functioning and structural aspects of quality of care. The individual in charge of the health facility at the time when the survey team visited the health facility was asked to be the respondent for this survey module. The main themes that were covered by the facility assessment included:

• Facility staffing, including the staffing complement of the facility, staff on duty at the time of the survey team’s visit and staff present at the time of the survey team’s visit
• Facility infrastructure and equipment
• Availability of drugs, consumables and supplies at the health facility
• Supervision
• Record keeping and reporting to the Health Management Information System
• Facility management
• Official user charges at the facility
• Revenues obtained at the health facility, and how revenues have been used

Health worker interview module
For health facilities with more than five health workers, a list of all clinical staff who worked in the area of maternal and child health providing prenatal or under five consultations was obtained. If this list contained more than five people, study enumerators interviewed a random sample of these health workers. If the list contained fewer than five people, all clinical personnel working in maternal and child health were interviewed. The interviews focused on the following areas:

• Role and responsibilities of the interviewed health worker
• Compensation, including delays in salary payments
• Staff satisfaction and motivation

Observations of patient-provider interaction module
While the health worker interview module collects information on what health workers know, the purpose of this module is to gather information on what health workers actually do with their patients.

A member of the survey team observed consultations with a systematic random sample of patients under five presenting with a new condition (i.e., not for follow-up visits or routine) and new ANC clients. The observer used a structured format to note whether key desired actions were carried out. In the case of patients under five, the instruments were focused on whether IMCI protocols are followed. For ANC clients the instruments examined whether key desired actions (including counseling) were carried out. As primary care facilities do not offer ANC services on all days of the week – typically these are offered 2 days each week – the ANC module was not conducted at all health facilities. During the baseline survey, 5 under-5 and 5 ANC observations were conducted at each facility where these modules are implemented. After finding that many health facilities did not offer ANC on the day of the survey at baseline, during the endline survey enumerators were asked to interview as many women receiving ANC on the day of the survey as possible to increase the sample size. All health workers selected for patient-provider observations will be included in the health worker interview sample.

Patient exit interviews
Enumerators conducted an exit interview with all patients whose consultation was observed as part of the study procedures. If the patient was a child, the child’s caregiver was interviewed. The under-fives included in the patient exit sample were the same children whose consultation with a provider was observed. In addition to this, exit interviews were conducted with all ANC clients whose consultation with a provider was observed.