consultations in Cameroon and Nigeria B6.7.1 Patient socioeconomic status, PBF, DFF, and know-can-do gaps

facility quality is not observed, the welfare implications of this effect are unclear. If public institutions are of lower quality than private institutions, then, if anything, patients may be worse off due to this shift. It is also noteworthy that the analysis of pooled data from these five countries leads to a different finding than what might be suggested by individual impact evaluations. For example, in Nigeria, Rwanda, Zambia, and Zimbabwe, the findings show that PBF outperformed DFF for institutional delivery, while the pooled analysis does not find an aggregate effect of PBF on institutional deliveries. This difference between the individual impact evaluations and the pooled analysis highlights the salience of context as a mediator of PBF’s impact.

Figure 6.5 compares the impacts of PBF and DFF on idle capacity. As discussed in chapter 3, idle capacity measures the potential for

Figure 6.5 Impacts of PBF relative to DFF on idle capacity in antenatal care consultations in Cameroon and Nigeria

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

–1.0 –0.5 0 0.5 1.0

Treatment effect of PBF on idle capacity Cameroon Nigeria

Source: 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. DFF = direct facility financing; PBF = performancebased financing.