know-can-do gap—in Cameroon and Nigeria

Figure 5.6 Impacts of performance-based financing on idle capacity—or the know-can-do gap—in Cameroon and Nigeria

Component of idle capacity Share of idle capacity Counseling: Nutrition Test: HIV Physical exam: Fetal heartbeat Test: Hemoglobin Test: Syphilis Preventive exam: Antimalarials Physical exam: Uterine height Asked: Last menstrual period Physical exam: Weight Counseling: Danger signs Asked: Blood group/rhesus Physical exam: Check for edema Preventive: insecticide-treated bed net Test: Urine Physical exam: Blood pressure Preventive: Iron/folic pills Asked: Currrent pregnancy danger signs

–1.0 –0.5 0 0.5 1.0

Treatment effect of PBF on idle capacity Cameroon Nigeria

Sources: World Bank, based on Khanna et al. 2021 and de Walque et al. 2021.

Note: Markers above the dashed line indicate a summary effect. Solid markers indicate statistically significant estimates (p < .05); markers that are open indicate imprecise estimates. “Whiskers” around markers represent 95% confidence intervals. PBF = performance-based financing.

Overall, the findings do not show that PBF reduces idle capacity compared with business-as-usual. If anything, they show a small increase in idle capacity in Cameroon. Unpacking these overall estimates, significant and large increases are estimated for idle capacity in both Cameroon and Nigeria for some dimensions of clinical quality. For instance, in Cameroon, a large increase is estimated in idle capacity in nutrition counseling, although the analysis also estimates a sizable reduction in idle capacity for counseling for danger signs. In Nigeria, there are increases in idle capacity for essential testing, including for HIV and syphilis. While the increases in idle capacity may be cause for concern, they may at least partially be explained by the role played by out-of-pocket payments at baseline. For instance, in Nigeria, at baseline the average out-of-pocket payment was US$2.40 (Kandpal et al. 2019), although in Cameroon out-of-pocket payments are not typically made for ANC (de Walque et al. 2021). The PBF