IMPACT EVALUATION OF COMMUNITY RESULTS BASED FINANCING ON EARLY INITIATION OF ANTENATAL VISIT AMONG PREGNANT WOMEN: A MATCHED PAIR, PARALLEL DESIGN CLUSTER RANDOMISED TRIAL

Results Based Financing (RBF) has been heralded as an effective tool for motivating health workers to improve maternal and child health indicators. However, focus has been on frontline health workers and little attention has been given to Community Health workers (CHWs). Yet CHWs have been found to be an effective cadre in improving maternal, newborn, and child health indicators, including ANC and facility deliveries. The study proposes to evaluate the effect of the community RBF on initiation of antenatal care in the first trimester. To achieve this, we will employ a cluster-randomized trial with pairwise matching where 49 health facilities are randomly allocated to the treatment arm and 49 to the control arm in Central province in Zambia. The study is targeted at Central province due to the relatively poor performance in the province. In each of the health facilities, 6 neighborhood health committees will be informed that for each woman they bring for ANC within the first trimester, they will be paid a fee. To ensure balance between the intervention and control, we will use administrative data on health facility characteristics such as distance to the district medical office, number of maternity beds and population catchment area to implement a covariate constrained pairwise matching procedure. We also examine whether incentivising first antenatal attendance translates to increased facility deliveries and whether other non-incentivized indicators such as post-natal attendance in the first six days post-delivery increase in line with an increase in the timing of first ANC visit.