IMPROVING EFFECTIVE COVERAGE IN HEALTH
care (ANC) equipment, essential drugs, and supplies. These impacts can be sizable, as reported in the literature. Figure 5.2 illustrates the impacts of PBF on essential structural capacity for ANC in Cameroon and Nigeria— the two countries among the five Sub-Saharan African countries studied in chapter 4 for which there are complete impact evaluation data. An overall index of structural quality and an index of all drugs and supplies are reported above the dotted line in the figure. Increases in structural quality would be to the right of the zero vertical line. The figure shows significant impacts of PBF on many dimensions of structural quality in both countries, although the improvements are far from universal in either context. Indeed, in both countries, a few drugs became less available relative to business-as-usual. At the same time, the evidence suggests there were no meaningful impacts on health worker knowledge. As discussed in the theoretical framework, PBF pilots have the potential to increase health worker knowledge, but this broad-based finding of a null impact suggests that in practice, at least in these contexts, the channels—job aids, salience, and so forth—through which PBF interventions might increase knowledge are not the binding constraints to the production of health worker knowledge. Figure 5.2
Impacts of performance-based financing on facility physical capacity in Cameroon and Nigeria Overall index Drugs index Hemoglobin test kit Urine test kit Tetanus toxoid (combined) Measuring tape Antimalarial drugs (coartem) Pregnancy test kit HIV test kit Blood pressure cuff Weighing scale Obstetric stethoscope Antibiotics (amoxicillin) Syphilis test kit
Iron supplement (with or without folic acid) Antimalarial drugs (fansidar) –0.6 –0.5 –0.4 –0.3 –0.2 –0.1
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Treatment effect of PBF on structural capacity Cameroon
Nigeria
Sources: World Bank, based on Khanna et al. 2021 and de Walque et al. 2021. Note: Solid markers indicate statistically significant estimates (p < .05); markers that are open indicate imprecise estimates. “Whiskers” around markers represent 95% confidence intervals. Components of the drugs index are in bold along the y axis. PBF = performance-based financing.
108
