A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

1. Impact Evaluation Note
Country: The Gambia
Modou Cheyassin Phall, Bakary Jallow, Dr. Abdou
Jammeh, Rifat Hasan, Günther Fink!
H E A LTH R ESU LTS IN NOVATION TRUS T FU N D

2. 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)

3. 1.2 Background cont…
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4. 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)

5. 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

6. 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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7. 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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8.  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
CommunityRBF
Comparison Group A
X
Group C
Treatment Group B Group D

9. 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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10. 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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