Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi
Includes bibliographical references (page 16-17).
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BMC Health Services Research
2016
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10361-51882019-09-30T02:56:19Z Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi Brenner, Stephan Muula, Adamson S Robyn, Paul Jacob Bärnighausen, Till Sarker, Malabika Mathanga, Don P Bossert, Thomas Allegri, Manuela De James P Grant School of Public Health, BRAC University Mixed methods Impact evaluation Performance-based incentives Study design Includes bibliographical references (page 16-17). Background: In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. Design: The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure ‘equitable access to healthcare services’ at the community level and ‘healthcare quality’ at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time. To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Discussion: Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach. Stephan Brenner Adamson S Muula Jacob Robyn Till Bärnighausen Malabika Sarker Don P Mathanga Thomas Bossert Manuela De Allegri 2016-04-25T16:52:51Z 2016-04-25T16:52:51Z 2014 2014 Article Brenner, S., Muula, A. S., Robyn, P. J., Bärnighausen, T., Sarker, M., Mathanga, D. P., … De Allegri, M. (2014). Design of an impact evaluation using a mixed methods model--an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi. BMC Health Services Research, 14(1), 180. http://doi.org/10.1186/1472-6963-14-180 1472-6963 http://hdl.handle.net/10361/5188 en BRAC University Journals are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. 17 pages application/pdf BMC Health Services Research |
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Brac University |
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Institutional Repository |
| language |
English |
| topic |
Mixed methods Impact evaluation Performance-based incentives Study design |
| spellingShingle |
Mixed methods Impact evaluation Performance-based incentives Study design Brenner, Stephan Muula, Adamson S Robyn, Paul Jacob Bärnighausen, Till Sarker, Malabika Mathanga, Don P Bossert, Thomas Allegri, Manuela De Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| description |
Includes bibliographical references (page 16-17). |
| author2 |
James P Grant School of Public Health, BRAC University |
| author_facet |
James P Grant School of Public Health, BRAC University Brenner, Stephan Muula, Adamson S Robyn, Paul Jacob Bärnighausen, Till Sarker, Malabika Mathanga, Don P Bossert, Thomas Allegri, Manuela De |
| format |
Article |
| author |
Brenner, Stephan Muula, Adamson S Robyn, Paul Jacob Bärnighausen, Till Sarker, Malabika Mathanga, Don P Bossert, Thomas Allegri, Manuela De |
| author_sort |
Brenner, Stephan |
| title |
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| title_short |
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| title_full |
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| title_fullStr |
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| title_full_unstemmed |
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi |
| title_sort |
design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in malawi |
| publisher |
BMC Health Services Research |
| publishDate |
2016 |
| url |
http://hdl.handle.net/10361/5188 |
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1814309679478603776 |