Chansaly ,Feng Mingliang, Du Jing, Victor Hsu, Jin Young Hyun, Se Eun Park, SuhYoonKang, Ying Lin, Sisamone Keola, Eunji Choi, Kwang-Geol Cho
Seoul, Korea
December 2010
Evaluating Impact:
Turning Promises into Evidence
Scaling up Health Equity Fund in
Lao PDR
1. Background
Project Coverage
72 poor districts and 27 priority districts (very poor
district)
Project Objectives
(1) Increase access and utilization of health service to the
poor
(2) Improve health outcomes of the poor beneficiaries
(3) Improve quality of health services
HEF Target Districts
HSIP/SRC
Sepon
Champhon
Phalanxay
Taoy
Kalum
DakjungThataeng
LamamSukhuma
3
Pre-identification
using CPA
CBHI premium
purchase
Geographic
targeting30 districts
(25%)
30 districts
(27%)
2015-2020 2011-2015
HEF schemes
in Lao PDR
Management
Policy – Guidance - Oversight
o HEF committees Central, Province, District, Village
Coordination-Consolidation-Evaluation:
o MOH Central HEF Unit
HEF Implementation
o HEF implementing agency: SRC/LRC-MWH-CBHI
Service delivery
o Public & Community Health facilities
4
HEF Membership
1. Pre-identification by Proxy Mean testing (PMT)
and provide HEF card to HEF families
2. Post-identification by Proxy Mean testing
3. Geographical targeting
4. All pregnant women
5
2. Benefit PackageA. Core package
1.Treatment in facility (drugs, supplies, exams, fees for all services in consultation, admission, delivery, surgery)
2.Transportation, including ambulance fee, from village to the health facilities and back home
3.Food allowance for admitted patient
B. Specific services for Pregnant women o Free maternity for all women
C. Other services o Funerals
o Basic items, including bed net, blanket, clothing, nutrition, and cooking utensils (case by case basis)
6
3. Results Chain
o USD$55,000
from WB
o USD$500,000
from Swiss
Red Cross
o Facilities,
staffs from
the gov’t
INPUTS ACTIVITIES OUTPUTS OUTCOMESLONGER-TERM
OUTCOMESHIGHER ORDER GOALS
1-1-1 & 1-2-1. & 2
Provision of free
medical care for
the poor
1-1-1 & 1-2-1. &2
Pay for medical
care,
transportation,
food for the
poor
3-1-1. Human
resource
capacity building
3-2-1. Set up a HEF
monitoring
committee
3-3-1. Identify “the
poorest of the
poor”
3-3-2. Provide identity
card
4-1-1. Awareness
campaign on the
HEF and the
importance of
health care
1-1. Pregnant women
giving birth at
the health
centers
1-2. Target
beneficiaries
attending OPD
and IPD
3-1. Staff trained on
health equity
fund
management
3-2. Target
beneficiaries are
satisfied with the
health services
received
through the
health equity
fund
3-3. Data
management of
the list of
beneficiaries
4-1. Target
beneficiaries are
educated on
their rights to
access to health
services
1. Increased
utilization of
health
services
2. Quality
health
services
provided
3. Improved
management
of the equity
fund system
4. Increased
public
awareness
on the health
care
o DIRECT
GOAL:
Decrease in
maternal &
infant
mortality
rate
(MMR&IMR)
o INDIRECT
GOAL:
Decrease in
the poverty
rate number
of people
living under
the extreme
poverty line
(US$1/day)
3. Primary Research Questions
I. What is the impact of provision of free health services
on the increase utilization of health services by the
poor beneficiaries?
II. What is the impact of provision of free health services
on the quality of health care services provided at the
target health facilities?
III. What is the impact of campaign on the increased
public awareness on the importance of health care?
IV. What is the impact of the training of the health equity
fund committee and the health providers (at the target
health centers) on functioning of health equity?
4. Outcome IndicatorsWhat is the impact of provision of free health services on the increase
utilization of health services?
Number of pregnant women giving birth at health centers
Number of target beneficiaries attended OPD and IPD
What is the impact of provision of free health services on the quality of
health care services provided at the target health facilities?
Number of health providers who follow the national treatment
guideline/standard
Percentage of patients who recover through the health services
provided
What is the impact of campaign on the increased public awareness on
the importance of health care?
Number of pregnant women who understand the importance of
ANC, delivery and PNC
Number of beneficiaries who understand the preventive measures
for diarrhea and malaria
5. Identification Strategy/ Method
What is the impact of provision of free health services
on the increase utilization of health services?
- Regression Discontinuity
- Or Randomized Assignment
What is the impact of provision of free health services
on the quality of health care services provided at the
target health facilities?
- Randomized Assignment
What is the impact of campaign on the increased public
awareness on the importance of health care?
- Qualitative Study
6. Sample and Data
I-1. Randomized Assignment
ㅇ30 Districts – Treatment group(Starting in 2011)
30 Districts – Control group(starting in 2015)
* 60 poor & poorest districts and 200 households per
district are randomly selected (power calculation will be
done to determine exact sample size)
ㅇ Household Baseline Survey: OPD, IPD, Diarrhea, ARI,
malaria, ANC, EPI, and criteria related to identification
(PMT), other variables necessary for multiple regression.
I-2. RD
ㅇ poverty index(cut off 12)
6. Sample and Data
II. Randomized Assignment
ㅇ Randomized selection of facilities in 60 districts
(10 facilities per district)
ㅇ 20 patients per facility
III. Qualitative Study
ㅇ Sample and Data used for I-1 above.
ㅇ Baseline survey before and after campaign(use existing
national health survey)
7. Time Frame / Work Plan
…Main out-put activities for HEF pilot project in five districts of Health Service Improvement Project
OUT -PUT
10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
Program star-up
1. Three-year strategic Plan for pilot HEF implementation developed
2. Annual Operational Plan and workplan for pilot HEF developed
3. Monitoring and Evaluation framework developed
Design Phase
1. Report on the design of training program for provincial, disricts, HC, PHO,
DHO and health facilities staff.
2. Report on design a system of HEF beneficiaries identification (BIS)
Implementation Phase
1. Completion report on training and capacity building ativities for all HEF
stakeholders2. Completion report on a system of HEF beneficiaries identification including
the list of eligible poor household enterd in excel spreadsheets as well as
computer record keeping to generate reports of utilization and financial data
Providing benefit and Monitoring Phases
1. Submission of Monthly, Quarterly and Annually report on HEF activities
and health services provision the poor beneficiaries.
2. Submission of Monthly, Quarterly and Annually on financial report of HEF
activities including capitation, reimbursement , administration and etc.
3. Monitor the activities of all actors involved in HEF implementation and
management
4. Final report and recommendation on HEF Implementation
Note: Annual report Monthly report Quaterly report
Out-put report frequency of M$E draft final report
2008 2009 20102011 2015
8. Sources of Financing
…US $
@ 1.26805 as per
15.11.2008@ 8’550 per 15.11.2008 Remark
I. Program star-up
1 Remuneration 8,525 10,810 92,426,5792 Reimbursable Expenses 0 0 03 Sub totals 8,525 10,810 92,426,579
II. Design Phase
1 Remuneration 13,169 16,699 142,776,0262 Reimbursable Expenses 0 03 Sub totals 13,169 16,699 142,776,026
III. Implementation Phase
1 Remuneration 18,512 23,474 200,703,9112 Reimbursable Expenses 20,000 25,361 216,836,5503 Sub totals 38,512 48,835 417,540,461
IV. Providing benefit and Monitoring Phases
1 Remuneration 128,498 162,942 1,393,153,1502 Reimbursable Expenses 34,471 43,711 373,728,6363 Sub totals 162,969 206,653 1,766,881,786
1. Submission of Monthly, Quarterly and Annually report on HEF activities and health services provision the poor
beneficiaries;2. Submission of Monthly, Quarterly and Annually on financial report of HEF activities including capitation,
reimbursement , administration and etc;3. Monitor the activities of all actors involved in HEF implementation and
management ;4. Final report and recommendation on HEF Implementation
GROUP OF ACTIVITIES (PHASE)
DESCRIPTION
Development of Three-year strategic Plan for pilot HEF implementation developed; Annual Operational Plan and workplan
for pilot HEF developed; Monitoring and Evaluation framework developed
Design of training program for provincial, disricts, HC, PHO, DHO and health facilities staff;Design a system of HEF
beneficiaries identification (BIS)
1. Training and capacity building ativities for all HEF stakeholders;2. Completion report on a system of HEF beneficiaries
identification including the list of eligible poor household enterd in excel spreadsheets as well as computer record keeping to
generate reports of utilization and financial data
Thank you
Q & A
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