Design of an impact evaluation using a mixed methods model – An explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi

  • BMC Health Services Research, Volume 14, No. 1, Year 2014

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Study Justification:
– The study aims to evaluate the impact of providing supply-side performance-based financing incentives and demand-side cash transfers on maternal healthcare services in Malawi.
– The intervention is introduced in selected emergency obstetric care facilities and catchment areas in four districts.
– The study will assess the effects of the intervention on equitable access to healthcare services and healthcare quality.
– The research aims to provide robust evidence on the outcomes of the intervention and generate insights on how and why the interventions produce certain effects.
Study Highlights:
– The study uses a mixed methods explanatory design, combining quantitative and qualitative research components.
– The quantitative component employs a controlled pre- and post-test design with multiple post-test measurements.
– The qualitative component includes in-depth interviews and focus group discussions with providers, service users, non-users, and policy stakeholders.
– The design allows for a comprehensive understanding of the expected and unexpected effects of the intervention on both access and quality of healthcare services.
– The study will use a difference-in-difference analysis to estimate the overall causal impact of the intervention.
Study Recommendations:
– Implement supply-side performance-based financing incentives and demand-side cash transfers in emergency obstetric care facilities and catchment areas to improve maternal healthcare services.
– Monitor and evaluate the effects of the interventions on equitable access to healthcare services and healthcare quality.
– Use a mixed methods approach to gain a comprehensive understanding of the effects and to identify organizational and behavioral changes affecting complex processes.
Key Role Players:
– Researchers and evaluators
– Healthcare providers
– Service users
– Non-users
– Policy stakeholders
Cost Items for Planning Recommendations:
– Research and evaluation team
– Data collection and analysis
– Training and capacity building for healthcare providers
– Implementation of supply-side performance-based financing incentives and demand-side cash transfers
– Monitoring and evaluation activities
– Communication and dissemination of findings

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Background: In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. Design. The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure ‘equitable access to healthcare services’ at the community level and ‘healthcare quality’ at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time. To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Discussion. Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach. © 2014 Brenner et al.; licensee BioMed Central Ltd.

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The innovation described in the article is the design of an impact evaluation using a mixed methods model to assess the effects of results-based financing mechanisms on maternal healthcare services in Malawi. This approach combines quantitative and qualitative research methods to evaluate the impact of providing supply-side performance-based financing incentives and demand-side cash transfers on equitable access to and quality of maternal and neonatal healthcare services. The study protocol includes a controlled pre- and post-test design with multiple post-test measurements to measure access to healthcare services at the community level and healthcare quality at the health facility level. The qualitative component includes in-depth interviews and focus group discussions with providers, service users, non-users, and policy stakeholders to understand the experiential dimensions of financial incentives on clients and providers. This mixed methods approach allows for a comprehensive understanding of the expected and unexpected effects of the intervention on both access and quality of maternal healthcare services.
AI Innovations Description
The recommendation described in the article is to conduct an impact evaluation using a mixed methods model to assess the effects of results-based financing mechanisms on maternal healthcare services in Malawi. The intervention involves providing supply-side performance-based financing incentives and demand-side cash transfers to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi.

The study design includes a quantitative research component and a qualitative component. The quantitative component uses a controlled pre- and post-test design with multiple post-test measurements to measure equitable access to healthcare services at the community level and healthcare quality at the health facility level. Various input, process, and output indicators are used to evaluate both intended and unintended effects of the intervention. Causal impact estimates will be obtained through a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.

The qualitative component involves in-depth interviews and focus group discussions with providers, service users, non-users, and policy stakeholders. This component aims to further explain heterogeneity of observed effects and understand the experiential dimensions of financial incentives on clients and providers. The qualitative data will be triangulated with the quantitative data to gain a comprehensive understanding of the expected and unexpected effects of the intervention on both access and quality of maternal healthcare.

By combining a quasi-experimental design with a mixed methods approach, this recommendation allows for a more in-depth evaluation of the organizational and behavioral changes affecting complex processes. It will generate robust evidence on the outcome of interest and provide insights into how and why the interventions produce certain intended and unintended effects.
AI Innovations Methodology
The article describes a study design to evaluate the impact of providing supply-side performance-based financing incentives and demand-side cash transfers on access to and quality of maternal and neonatal healthcare services in Malawi. The study design incorporates both quantitative and qualitative research methods to assess the effects of the intervention.

The quantitative research component involves a controlled pre- and post-test design with multiple post-test measurements. This allows for the measurement of “equitable access to healthcare services” at the community level and “healthcare quality” at the health facility level. The study uses a theoretical framework of causal relationships and identifies input, process, and output indicators to evaluate the intended and unintended effects of the intervention. Causal impact estimates will be obtained through a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.

To further understand the experiential dimensions of financial incentives on clients and providers, a qualitative component is included. This component involves in-depth interviews and focus group discussions with providers, service users, non-users, and policy stakeholders. The qualitative component aims to explain the heterogeneity of observed effects and provide a comprehensive understanding of the expected and unexpected effects of the intervention on access and quality.

By combining a quasi-experimental design with a mixed methods approach, the study design allows for a more in-depth evaluation of the organizational and behavioral changes affecting complex processes. This approach not only generates robust evidence measures for the outcome of interest but also provides insights into how and why the interventions produce certain intended and unintended effects.

Statistics:
Citations: 34
Authors: 8
Identifiers:
DOI: 10.1186/1472-6963-14-180
Research Areas:
Community Interventions, Disparities, Genetics and Genomics, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Malawi
Study Design:
Quasi Experimental Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
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