Rwanda Community Performance-Based Financing Impact Evaluation 2013
Rwanda, 2013 - 2014
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RWA_2013_HRBFIE-HH_v01_M
Rwanda Community Performance-Based Financing Impact Evaluation 2013
Household Follow Up Survey
| Name | Country code |
|---|---|
| Rwanda | RWA |
Other Household Health Survey
The Baseline survey for The Community Performance-Based Financing Impact Evaluation (Households) was conducted in Q1-Q2 2010
The Follow up survey was conducted from Q4 2013 to Q2 2014. Data collection consisted of household, Community Health Worker(CHW) and CHW cooperative surveys.
Since June 2006, Rwanda has implemented a national supply-side performance-based financing (PBF) program in hospitals and health centers. This ‘first generation’ PBF program provided financial rewards to health facilities in order to promote maternal, child, and HIV/AIDS healthcare. A prospective, rigorous impact evaluation (IE) was developed with the commitment of the Government of Rwanda (GOR) to assess the impacts of PBF on health outcomes and determine the possibility of scaling-up the PBF initiative nationwide. The IE showed significant positive impacts on quality of prenatal care, as well as increased utilization of institutional delivery and child preventive care services. However, it highlighted the limited effect of the supply-side intervention on other services, such as the demand for timely prenatal care and family planning.
In 2010 the ‘second generation’ of PBF in Rwanda, the Community Performance-Based Financing (CPBF) program, was initiated to tackle the remaining issue of low utilization of health services by mothers and their children. The Community PBF implemented the following three interventions: (i) demand-side in-kind incentives for women, (ii) financial rewards for community health worker (CHW) cooperatives, and (iii) combined demand-side and CHW rewards. The three CPBF interventions were introduced in October 2010 in randomly selected sectors.
The CPBF program is evaluated by a prospective, randomized impact evaluation (IE). The IE evaluates the causal effect of the CPBF interventions on maternal and child health outputs and outcomes. This report presents analysis of the IE data that assessed the program impact by comparing outcomes in sectors implementing the three different interventions and a comparison group of sectors not implementing any of the interventions. The IE relies on baseline (Q1-Q2 2010) and follow up (Q4 2013-Q2 2014) data collection, consisting of household, CHW and CHW cooperative surveys. A health facility assessment was conducted at the follow up survey.
The endline survey for the impact evaluation was fielded from November 2013 to June 2014. The University of Rwanda College of Medicine and Health Sciences School of Public Health (UR-CMHS-SPH) managed all activities related to data collection and entry. The baseline survey questionnaires were adapted to account for the modification to the sample described in the previous chapter. In addition, modules asking about the experience with the CPBF program have been added. Because the baseline survey did not include the health facility assessment, the relevant questionnaires were created by adapting the Health Results Innovation Trust Fund (HRITF) samples. Apart from the health facility assessment that was conducted in French, all other interviews were conducted in Kinyarwanda.
The household questionnaire duration was approximately 120-150 minutes after having introduced the team and explained the purpose of their visit. Each field team was composed of 8 members and led by a team supervisor. All enumerators recruited were trained in biometric and anthropometric measurement. At the end of the interview, the interviewer would give caregivers feedback about the relevant health outcomes (e.g. anemia status, child nutrition status) of the children. In the event that study personnel identified children with serious health problems, the medical professional on the team provided the caregiver with information about where and how to seek medical care (usually at the closest medical center). The study team did not provide direct medical care to participants. There was no financial payment to participants enrolled in the study. However, each household received a contribution of 3,000 RWF for the community health insurance scheme (Mutuelle de santé) for one household member.
This dataset contains the data from the follow up household survey. In each village from the baseline sample, the survey team was to re-interview the baseline women, interview the women with the most recent birth or pregnancy in the village. These women were defined as the ‘core respondents’ and their households were selected for the survey. 4,468 Households are included in the dataset, 2157 with baseline women and 2343 with a recent birth or pregnancy. Thirty-two households fall into both categories.
Because of the costs implied the large sample, the research team decided to narrow the scope of the household survey relative to that in the baseline. Some of the sections have been shortened. In addition, the survey is focused to greater extent on the core woman, defined as the woman who gave the birth that led to the selection of the household. The women questionnaire was only administered to these women (and not all women of ages 15-49 as in the baseline). The Child questionnaire only covered children of the core respondent, and not all children in the household.
Sample survey data [ssd]
Households; Women; Children
Scope
Main household questionnaire. The main respondent for the household-level questionnaire is the head of household and/or spouse, although they may ask for support from other household members on specific questions regarding the household. A Health Knowledge module was administered to the spouse of the core respondent.
The household survey includes eight sections:
- Roster: This section collects the basic demographic data, including age, birth date, marital status and parental education levels, for all household members.
- Education: This section collects data on current and completed levels of education, current attendance and time allocation for all household members 5 years and older.
- Labor: This section collects data on current primary and secondary employment activities (income generating or other), and on other compensation such as insurance, unemployment or retirement benefits for all household members 12 years and older.
- Health Knowledge: The section is administered to the spouse of the core respondent (if the core respondent is married and cohabiting with the spouse) complemented by the same questionnaire that is administered to the core respondents.
- Housing: This section collects data on all characteristics of the house, such as floor, roof and wall material, water and sanitation, fuel sources and rent.
- Assets: This section collects data on the asset holdings and value of assets of the household, including land, equipment and animals.
- Transfers: This section collects data on all possible sources of income, including investments, rentals, scholarships, remittances and inheritance. The section also collects data on Subjective Life Valuation (SLV).
- Mortality: This section collects data on any deaths of household members in the last 12 months, as well as the cause of death.
Female questionnaire. The respondent(s) for the maternal health modules is the core respondent, defined as the female whose pregnancy led to the selection of the household.
9. Health Status and Utilization: This is an extended version of Section 4 in the household-level interview, and collects data on morbidity, access to care, diagnosis and treatment, as well as out-of-pocket expenditures.
10. Mental Health: This section collects data to assess the woman’s mental health, and any treatment for recent depression and/or anxiety.
11. Reproductive Health: This section collects data on the woman’s desire for more children, history of contraceptive use, as well as current use.
12. Pregnancy History: This section collects data on all the pregnancies within the woman’s lifetime, including live births, miscarriages and stillborns, as well as a summary of all the woman’s living and non-living children.
13. Birth History: This section collects data on the woman’s birth history and is individual level data for each birth, on birth date if the child is still living and date of death if the child is no longer living.
14. Maternal Health: This is an extensive section which collects data on the woman’s prenatal, delivery and post-natal care for pregnancies in the last 3 years including current pregnancies. For most of the RBF projects, prenatal, delivery and post-natal care utilization are core indicators for the success of the project. This section collects data on service utilization and quality of care (as measured by provider’s adherence to national protocol).
15. Patient Satisfaction: This section collects data on the woman’s satisfaction with community health worker and health facility services.
16. Health Knowledge: This section complements the Health Knowledge section in the Community Health Worker survey and collects data on the woman’s knowledge of specific health-related categories, including hand washing, water, sanitation, pregnancy danger signs, child nutrition, vaccination, contraception, tuberculosis, malaria and child illness.
Child health and biomarker questionnaire. The respondent(s) for the child health modules is the core woman who report information on her children who are 0-5 years old.
17. Health Status and Utilization: This is an extended version of Section 4 in the household-level interview, and collects data on morbidity, access to care, diagnosis and treatment, as well as out-of-pocket expenditures.
18. Vaccination and Immunization: This section collects data on the child’s vaccination history at the facility. It also collects data on the child’s vaccination history during community health campaigns and on recent administration of vaccines or vitamin A.
19. Anthropometrics: This section collects data to measure the child’s nutritional status by collecting the child height and weight. This data is used to compute the child’s Z-score.
20. Anemia Tests: This section collects data on the additional anemia test measured through hemoglobin concentration. Enumerators trained in biometric data measurement administered the test after obtaining caregivers’ consent.
Coverage
198 sectors (sub districts) in 19 districts in 4 provinces
Sub-district
Producers and sponsors
| Name | Affiliation |
|---|---|
| Gil Shapira | DECHD |
| Ina Kalisa | University of Rwanda College of Medicine and Health Sciences school of Public Health |
| Name | Affiliation |
|---|---|
| James Humuza | University of Rwanda College of Medicine and Health Sciences school of Public Health |
| Jeanine Condo | University of Rwanda College of Medicine and Health Sciences school of Public Health |
| Vedaste Ndahindwa | University of Rwanda College of Medicine and Health Sciences school of Public Health |
| Name |
|---|
| Health Results Innovation Trust Fund |
Sampling
According to the study design, the survey should have covered 200 sectors, 50 for each study arm. Of the 200 originally selected sectors, 12 did not meet the criteria of having a health center with an active CHW cooperative. While replacement sectors were assigned to the 3 treatment groups, there was no replacement sector assigned for the control group. Therefore, one sector of the control group has been dropped from the sample without being replaced. Another sector assigned to the control group has been wrongly coded in the data and subsequently also dropped from the sample. As a result, the final sample covered 198 sectors.
In each sector, the survey team was to interview women and CHWs in 12 different villages. During the fieldwork, the survey team learned that some villages, in five of the sectors, were served by health facilities different than the ones affiliated with the CHW cooperative selected for interview. In these cases, only the villages covered by the selected cooperatives were covered. The survey team increased the number of women and CHWs interviewed in these villages. 12 households in each sector were successfully interviewed.
Following the sampling strategy, the data was clustered at the sector level. The sectors in the study were not randomly assigned, i.e. the data is representative for the 233 eligible sectors. Villages, however, were randomly sampled with all villages within a sector having the probability 12/(# "villages per sector" ) of being
selected. Within each selected village, the household with the most recent birth or pregnancy was selected. Assuming birth is having the most recent birth in the village is random (uniform), the probability of a household being selected for the sample is given by 12/(number of "households in village" )·1/(number of villages in
sector ).
While the research team obtains administrative data on the number of villages in each sector and on the total number of households per sector, it does not obtain exact data on the number of households in each selected village. Therefore, it is assumed that within each sector the sizes of the villages are similar and the sampling weight is (number of households" in sector" )/12. This implies that all households within a sector have the same sampling weight.
Survey instrument
The Rwanda Community Performance-Based Financing Impact Evaluation 2013, Household Follow Up Survey utilized the following questionnaires:
- Main Household Questionnaire
- Woman Questionnaire
- Child Questionnaire
Data collection
| Start | End | Cycle |
|---|---|---|
| 2013-11 | 2014-06 | Data Collection |
Data collection period was extended in order to track baseline women who moved out of their baseline districts.
Depositor information
| Name | Affiliation |
|---|---|
| DECRG: Human Development | The World Bank |
Data Access
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Example:
World Bank, DECRG: Human Development. Rwanda Community Performance-Based Financing Impact Evaluation 2013, Household Follow Up Survey (HRBFIE-HH), Ref. RWA_2013_HRBFIE-HH_v01_M. Dataset downloaded from [url] on [date]
Contacts
| Name | Affiliation | URL |
|---|---|---|
| Microdata Library | The World Bank | microdata.worldbank.org |
Metadata production
DDI_RWA_2013_HRBFIE-HH_v01_M_WB
| Name | Affiliation | Role |
|---|---|---|
| Development Economics Data Group | The World Bank | Documentation of the DDI |
2016-08-29
Metadata version
Version 01 (August 2016)