1. The Strategic Impact Evaluation Fund (SIEF)
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Evaluations - Health

October 6, 2016

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HEALTH SYSTEMS AND SERVICE DELIVERY

 

In many developing countries, weak health systems and the prevalence of often-preventable diseases undermine efforts to reduce poverty and improve opportunities for people to build better lives for themselves and their children. SIEF-supported researchers are working with health ministries and non-governmental organizations to measure the effectiveness of new and existing initiatives to strengthen access to and quality of care, including better services for women and girls. The evidence generated will make it possible for development practitioners and policymakers around the world to learn what’s working and how they can apply these lessons for better health care and coverage for all. Read more about health and impact evaluation in our Cluster Note.

 

PORTFOLIO OF IMPACT EVALUATIONS 

 

Argentina: Does Giving Clinics Incentives for Better Care Work?

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: Researchers conducted a randomized experiment to evaluate the impact of the Plan Nacer program on the quality and quantity of prenatal care in Argentina. Plan Nacer provided temporary financial performance incentives to 18 medical care clinics in the Province of Misiones in 2010. The program was implemented by Argentina's Ministry of Health.

 

Burkina Faso: Can Cash Transfers Help Children Stay Healthy and Go to School?

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: Researchers conducted a randomized experiment to evaluate the impact of the Nahouri Cash Transfers Pilot Project in Burkina Faso’s Nahouri province, where poor families received either conditional or unconditional grants to encourage them to enroll their children in school and take them for regular check-ups. The program ran from 2008-2010.  The evaluation results helped the Government of Burkina Faso, working with the World Bank, develop a new social safety net program for the country. For further infromation, see our Burkina Faso Impact page.

 

China: Measuring the Impact of Incentives on Quality of Health Care

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: This project evaluated the impact of two health reforms in China’s Ningxia and Shandong regions. The Ningxia Project, in collaboration with the Bill and Melinda Gates Foundation, evaluated the impact of two key policy reforms. The first policy change was a redesign of the rural insurance benefit package, with an emphasis on reorienting incentives away from inpatient towards outpatient care. The second policy change involved a shift from a fee-for-service payment method to a capitation budget with pay-for-performance amongst primary care providers. The Shandong Project, in collaboration with the European Union, evaluated the impact of financial incentive schemes (pay-for-performance) on quality of care in pharmaceutical prescribing and spending in China.

 

India: Can Community-Based Programs Cut Down on Malaria Infections?

  • Timeline: Completed (Funded under SIEF 1)
  • India: The evaluation of a malaria prevention and treatment project from India’s National Vector Borne Disease Control Program sought to assess the effectiveness of early diagnosis of the disease on prevention and treatment outcomes in a very rural part of India.

 

India: Can Giving People a Day of Health Care Encourage Them to Use It More?

 

India: Impact of Social Accountability Interventions on Healthcare Delivery and Health Outcomes in Uttar Pradesh, India

  • Principal Investigators: Manoj Mohanan, Duke University; Harsha Thirumurthy, University of North Carolina at Chapel Hill
  • Timeline: 2014 – 2019
  • Evaluation: Uttar Pradesh, India’s largest state, with a population of more than 200 million, has among the lowest per-capita incomes in the country. Infant and child mortality rates are especially high and some 380,000 children under the age of five die every year. The Government of Uttar Pradesh, which seeks to improve its health care system, is piloting social accountability interventions and considering them for scale-up as part of a World Bank-supported project. Researchers are working with the government to evaluate the effectiveness of these campaigns.

 

India: Leveraging Patients' Social Networks to Overcome Tuberculosis Under-Detection in India

  • Principal investigators: Jessica Goldberg, University of Maryland; Mario Macis, Johns Hopkins University 
  • Timeline: Completed
  • Evaluation: About 3.5 million people in India are estimated to have tuberculosis, and one third of them either haven’t been diagnosed or aren’t receiving treatment. Infected people are often from the most vulnerable and marginalized communities and it’s difficult to make sure they know about treatments and how to minimize the spread of disease. The India-based non-governmental organization Operation ASHA, which operates 200 tuberculosis treatment centers, piloted a program that paid current patients for referring people who might have tuberculosis to government testing centers. Researchers working with the group carried out a randomized controlled trial to evaluate the program to understand what can – or cannot – improve outreach and treatment to those at risk.

 

Kenya: Advancing the Science of Delivery: A Proposed Impact Evaluation of Inspection Regimes in Health Care and Their Impact on Patient Safety Standards

  • Principal investigators: Jishnu Das, World Bank; Guadalupe Bedoya, World Bank
  • Timeline: 2015 - 2019
  • Evaluation: In Kenya, where clinics have limited budgets and health care quality is low, researchers are looking at how increased monitoring and providing information to patients about the clinics that serve them can improve the quality of care. The Government of Kenya wants to develop better approaches for monitoring and improving health care throughout the country, and this evaluation will provide the government with evidence for policies to strengthen the quality of care in private and public facilities.

 

Kenya: Can School Malaria Screening Help Kids’ Health and Education?

  • Timeline: Completed (Funded under SIEF1)
  • Evaluation: The evaluation of Kenya’s malaria prevention project sought to measure the effectiveness of intermittent preventive treatment on malaria to determine whether such treatment could increase school attendance and improve academic achievement.

 

Lesotho: Can Lottery Tickets Reduce Risky Sexual Behavior?

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: A financial incentives program gave lottery tickets to young people who tested negative for specific curable sexually transmitted diseases. The impact evaluation tested whether this would alter sexual behavior and reduce HIV incidence among youth.

 

Malawi: The Zomba Cash Experiment - Does Paying Girls’ School Fees Reduce Their Risk of HIV Infection?

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: The study of Malawi’s HIV prevention program sought to measure the effectiveness of paying for school fees and providing cash to girls who stayed in school with the goal of reducing the incidence of HIV in girls aged 13 to 22. For more information, see our Malawi page on the evaluation.

 

Nepal: Impact Evaluation of a Health Insurance Pilot

  • Principal investigators: Tekabe Belay, World Bank; Santadarshan Sadhu, Institute of Financial Management and Research (India)
  • Timeline: Cancelled
  • Evaluation: Nepal’s out-of-pocket health costs are rising and inequalities in access to health care are increasing. To combat this, the Ministry of Health and Population has been working to develop a strategy for universal health coverage. A proposed pilot project aims to determine the best insurance policy and overall financing strategy. Researchers hope to identify effective financing methods for the provision of comprehensive and equitable health services in low-income settings. Baseline data was collected (not yet publicly accessible). 

 

Nigeria: Can Community Training and Support Reduce Malaria Infections?

  • Timeline: Ongoing (Funded through SIEF1)
  • Evaluation: The evaluation of Nigeria’s Community-Directed Interventions and Private Sector Approaches to Malaria Control seeks to measure the effectiveness of training community volunteers and small private drug distributors in treatment and diagnostics of malaria for decreasing the incidents of malaria. Evaluation report pending.
  • DIME Nigeria Impact Evaluation Updates

 

Nigeria: Healthy Mothers and Healthy Babies: Testing Demand and Supply-Side Approaches to Maternal and Child Health

  • Principal investigators: Pedro Rosa Dias, University of Sussex; Marcos Vera-Hernandez, University College London; Marcus Holmlund, World Bank
  • Timeline: Completed
  • Evaluation: In Nigeria, approximately one million mothers and children die every year from preventable diseases. Three-quarters of these deaths wouldn't happen if existing healthcare services were used. Nigeria sought to reduce deaths from preventable diseases by improving use and quality of healthcare services available for women and children through the Subsidy Reinvestment and Empowerment Programme (SURE-P) Maternal and Child Health Program. Researchers evaluated various interventions within the program.

 

Philippines: Impact of Incentives and Information on Quality and Utilization in Primary Care (i3QUIP)

  • Principal investigators: Junko Onishi, World Bank; Taejong Kim, Korean Development Institute School of Public Policy and Management; John Basa, Philippines Health Insurance Corporation
  • Timeline: Cancelled
  • Evaluation: In the Philippines, the government has sought to improve the effectiveness of primary health care by expanding coverage of PhilHealth's social health insurance benefit package. Researchers will examine the impact of three measures being implemented: (i) direct payments to providers with increased autonomy on the distribution of the amount, (ii) increased disclosure of information, and (iii) a combination of direct payments and increased disclosure of information. Baseline data was collected (not yet publicly accessible). 

 

Rwanda: Can Bonus Payments Improve Care Usage and Care for Mothers and Children?

  • Timeline: Completed (Funded under SIEF 1)
  • Evaluation: The 23-month evaluation, the first rigorous one of its kind in a low-income country, found that performance-based bonuses to health providers helped raise the quality and use of some services for women and children. It also showed that provider incentives were less useful when it came to encouraging women to seek services in the first place. Based on the results, the Government of Rwanda created a complementary program that encouraged women to seek prenatal care by offering small for meeting certain goals for a healthy pregnancy and delivery.

 

Tanzania: RESPECT Study for Women at High Risk of HIV Infection in Dar-es-Salaam, Tanzania

  • Principal investigators: Damien de Walque, World Bank; William H. Dow, University of California, Berkeley; Admirabilis Kalolella, Ifakara Health Institute
  • Timeline: Ongoing
  • Evaluation: HIV prevention remains a top priority for the global health community, especially in sub-Saharan Africa, where 70 percent of the world’s estimated 25 million HIV-infected people currently live. Information campaigns to discourage risky sexual behavior have had limited success. Researchers are exploring the impact of using financial incentives to encourage safe sex in order to stem the spread of HIV. The evaluation in Tanzania will focus on high risk populations, such as female sex workers, to see if cash payments conditional on testing negative for HIV and other sexually-transmitted infections can help reduce risky behavior. 

 

Tanzania: Using Cash to Encourage Young Adults to Abstain from Risky Sexual Behavior

  • Timeline: Completed (Funded under SIEF1)
  • Evaluation: The impact evaluation of Tanzania’s cash payment program sought to measure the effectiveness of paying participants aged 18 to 30 to abstain from risky sexual behavior as determined by their remaining free of specific curable sexually transmitted diseases for a specific time period. (Anyone testing positive was offered free treatment, and all received counselling.) To read more, visit the Tanzania page on the study.

 

Zambia: Measuring New Ways Keep Rural Clinics Stocked with Essential Drugs

  • Timeline: Completed (Funded under SIEF1)
  • Zambia: Health experts and policymakers want people to have access to affordable and high-quality medical care. But in some developing countries, making quality healthcare available may first necessitate ensuring that essential medicines are available, such as anti-malaria pills and antibiotics. The challenge of guaranteeing a steady supply is not only related to the financial side of paying for medicines, sometimes it has to do with how to ensure that drugs are distributed properly and reach especially rural clinics. This evaluation tested different ways to supplying clinics with medicines in an attempt to reduce stock outs. For more information, read our Zambia Impact page.
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