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SHAPING THE LEARNING AGENDA
The way forward
Dinesh Nair and Jake Robbins
Program Implementation provides many
Opportunities for Learning
Q u a l i t a t i v e
L e a r n i n g
Two Broad Pathways to Learn
with opportunities to intertwine them
• Implementation Research and Delivery Science
• differe...
Implementation Research and
Delivery Science
The Five I’s of DDS
5
What results will DDS strive to achieve?
Support teams, countries and partners to:
6
Make the best possible investment dec...
India AIDS DDS Example
M
7
Operational Data helps track
sub national performance
0
5
10
15
20
25
30
35
40
45
1 2 3 4 1 2 3 4 1 2 3 4 1
2012 2013 2014...
Nigeria case study on key determinants
• What differentiate the good
and poor performers under
the PBF scheme?
• Health ce...
Detailed look at the operational data revealed the large variations in performance
across Health Centers
Institutional Del...
Case study on determinants suggests the importance of community engagement and
OIC management
Identified determinants and ...
Impact Evaluation
Impact evaluation
Impact Evaluation:
• Explores whether there is a causal link between the RBF
intervention and the result...
An Impact Evaluation Answers:
What was the effect of the program on
outcomes?
How much better off are the beneficiaries
be...
Cameroon RBF Impact evaluation design
• Research questions
1. Does the PBF program increase the coverage and of MCH
servic...
Cameroon RBF IE Midline Qualitative Study
• Focused on two primary themes:
• Experiences in the piloting of PBF at the cen...
Qualitative study: Sampling Methodology
PBF in Cameroun: Mid-line Qualitative Study Interview Format Total IDIs Total FGDs...
Qualitative study: Results
• Positive impact on service delivery
• Facilities are cleaner, more organized and better manag...
Discussion
• What opportunities exist to make Learning a key part of the GFF
Agenda
• How can “Learning” be mainstreamed t...
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Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop – Day 4 – Shaping the Learning Agenda: The Way Forward

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A presentation from the Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop, held in Nanyuki, Kenya.

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Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop – Day 4 – Shaping the Learning Agenda: The Way Forward

  1. 1. SHAPING THE LEARNING AGENDA The way forward Dinesh Nair and Jake Robbins
  2. 2. Program Implementation provides many Opportunities for Learning Q u a l i t a t i v e L e a r n i n g
  3. 3. Two Broad Pathways to Learn with opportunities to intertwine them • Implementation Research and Delivery Science • different forms: operations research, mixed method • helps understanding the context • Impact Evaluation • Establish causal link between observed results and evaluated program • Usually has a credible counterfactual, in the form of a valid control or comparison group, is critical
  4. 4. Implementation Research and Delivery Science
  5. 5. The Five I’s of DDS 5
  6. 6. What results will DDS strive to achieve? Support teams, countries and partners to: 6 Make the best possible investment decisions Respond to, generate demand for and deliver services to the best feasible standards, for the right people, in the right places, in the right ways, at the right time Achieve the best possible health impact Plan early to ensure that proven approaches are institutionalized and sustained
  7. 7. India AIDS DDS Example M 7
  8. 8. Operational Data helps track sub national performance 0 5 10 15 20 25 30 35 40 45 1 2 3 4 1 2 3 4 1 2 3 4 1 2012 2013 2014 2015 % Pilot Expansion 1 Expansion 2 Expansion 3 QUALITY OF CARE 0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 December March June September December March June September December March June September December March 2011 2012 2013 2014 2015 AxisTitle Axis Title Adamawa Nasarawa Ondo National Dynamic quality measures improve outcomes Recalibration of quantified quality checklist COVERAGE OF INSTITUTIONAL DELIVERY Coverage increases sustained over phases Nigeria
  9. 9. Nigeria case study on key determinants • What differentiate the good and poor performers under the PBF scheme? • Health center management • Contextual factors • Health systems factors (e.g., supervision) • Interviews, document review, direct observations • Best and poorest performers • Devise appropriate support to poor performers Research question Areas to look into Approaches Potential use
  10. 10. Detailed look at the operational data revealed the large variations in performance across Health Centers Institutional Delivery in Adamawa, normalized by 100,000 population - 20 40 60 80 100 120 140 Pariya HC Chigari HC Dasin Hausa HC Farang HC Ribadu HC Furore MCH HC Choli HC Gurin HC Malabu HC Karlahi HC Wuro Bokki HC Kabilo HC Saint Mary's Clinic HC Mayo-Ine HC • Before PBF, all health centers were equally at very low levels • After the PBF, some facilities achieved 100% coverage while others struggle with limited improvement
  11. 11. Case study on determinants suggests the importance of community engagement and OIC management Identified determinants and non-determinants (preliminary) Non-Determinants • Level of staffing (best performers lack staff) • Remoteness of facilities (best performers are very rural) • Technical qualifications of OIC (many community health workers manage facilities well) • Business planning (none use it effectively yet) Determinants • Community engagement (e.g., involve and reward community leaders, daily visits, incentivize for use of facility) • OIC’s management capacity (e.g., full staff involvement, improve staff environment using performance bonus, rigorous performance review)
  12. 12. Impact Evaluation
  13. 13. Impact evaluation Impact Evaluation: • Explores whether there is a causal link between the RBF intervention and the results. 13 P r o v i d e r Report ________ _quantity_ _quality__ _services_ _________ P u r c h a s e r Counter Verification Verification Contract ________ _quantity_ _quality__ _services_ _________ O u t p u t s O u t c o m e s IE IE
  14. 14. An Impact Evaluation Answers: What was the effect of the program on outcomes? How much better off are the beneficiaries because of the program/policy? How would outcomes change if one changed the program design?
  15. 15. Cameroon RBF Impact evaluation design • Research questions 1. Does the PBF program increase the coverage and of MCH services? 2. Is it the enhanced monitoring & evaluation and supervision or the link between payments and results that leads to improvements observed in quality or coverage? 3. What is the contribution of enhanced supervision and monitoring to improving MCH service coverage and quality in the absence of increased autonomy or additional financial resources? • Public randomization ceremonies in each region • Baseline June 2012, Endline June 2015 • Results expected by December 2015 • Midline qualitative study embedded in impact evaluation
  16. 16. Cameroon RBF IE Midline Qualitative Study • Focused on two primary themes: • Experiences in the piloting of PBF at the central, regional and district level: perspectives of decision-makers and policymakers • Experiential elements of health service delivery at the operational level: perspectives of patients and providers • Research questions: • What has been the experience of piloting performance-based financing at various administrative and operational levels of the health system in Cameroon? • What has been the experience of health service delivery for health workers, patients and community members during the first two years of Performance- based financing?
  17. 17. Qualitative study: Sampling Methodology PBF in Cameroun: Mid-line Qualitative Study Interview Format Total IDIs Total FGDs Proposed Sampling and # of IDIs and FGDs IDIs FGDs Central Level Ministry of Health 2 x 2 Development Partners 2 x 2 Regional Level (4 TOTAL Regions: NW, SW, Littoral, and East) Regional Health Delegates 1 x 4 District Medical Officers 2* x 8 IE Study Groups (T1, C1, and C2) District Hospitals and Primary Health Centres (Directors and Administrators) 6** x 72 Community Level Community Leaders 2*** x 32 x Community Members, Health Workers, etc. x 4/region*** 16 * 2 DMOs per region **Stratifed by IE Study Group; 18 total IDIs per region ***Following FGD catchment (2 per village/4 villages total/8 per region) GRAND TOTALS for Midline Qualitative Study ****Stratifed by T1/C2 IE Study Groups; Urban/Rural; Female only IDIs 120 FGs 16 136 interviews TOTAL
  18. 18. Qualitative study: Results • Positive impact on service delivery • Facilities are cleaner, more organized and better managed, staff motivated • Increased utilization and quality, price reduction for services • Better availability of drugs (breaking public monopoly) • Reduced under the table payments • Increased collaboration among the various stakeholders • Regional/district supervision teams and health facilities (in particular private health facilities) • Management tools and procedures used in PBF led to enhanced transparency and accountability in resource management • Obstacles encountered • Initial reluctance and adjustment of health facility staff to program • Obtaining initial buy-in and support of providers and ministry • Lack of confidence in Ministry of Health to follow through with promises • Challenges with increasing autonomy of health facilities 18
  19. 19. Discussion • What opportunities exist to make Learning a key part of the GFF Agenda • How can “Learning” be mainstreamed through Investment Cases, implementation plans , projects? • What technical and other support will be required to make this a reality? • How can we incentivize learning and dissemination to be a major part of the value proposition?

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