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Measuring and Understanding the Effects of a Performance Based Financing Scheme Applied to Nutrition Services in Burundi (NutriPBF)

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ClinicalTrials.gov Identifier: NCT02721160
Recruitment Status : Completed
First Posted : March 29, 2016
Last Update Posted : June 1, 2018
Sponsor:
Collaborators:
World Bank
Ministry of Health, Burundi
Institut de Statistiques, Burundi (ISTEEBU)
Institut National de Santé Publique, Burundi (INSP)
Information provided by (Responsible Party):
Institute of Tropical Medicine, Belgium

Brief Summary:

The government of Burundi is implementing a new financing scheme in health centres. The objective is to provide additional financial compensations to health centres on the basis of their performance in nutrition activities: it consists in the introduction of criteria focusing on malnutrition prevention and care activities in the existing performance based financing (PBF) system.

The general objective of this study is to assess the effects of this new financing scheme, to document its impact and to study the chains through which it occurred. This study will provide key evidence for countries with an existing PBF scheme and confronted with malnutrition problems on the appropriateness to extend the strategy to nutrition services. If this impact evaluation brings positive results, this may have implications for the global fight against malnutrition.


Condition or disease Intervention/treatment Phase
Malnutrition Other: Nutrition PBF Not Applicable

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 90 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Measuring and Understanding the Effects of a Performance Based Financing Scheme Applied to Nutrition Services in Burundi
Actual Study Start Date : December 2014
Actual Primary Completion Date : April 2017
Actual Study Completion Date : May 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malnutrition

Arm Intervention/treatment
Experimental: Nutrition PBF
45 health centres are assigned to this group. The intervention consists in a performance based financing scheme applied to nutrition services.
Other: Nutrition PBF

Nutrition PBF focuses on children under five years old. It follows the standard PBF model in Burundi and combines quantitative indicators to encourage an increase in service delivery (see Table below) and qualitative indicators. Quality of nutrition activities is assessed quarterly, and a bonus or penalty is applied to subsidies received by the facilities according to their quality score.

Table: Incentivized indicators

CHW level

  • nb of cases screened and referred to HC for acute malnutrition (AM)
  • nb of classes promoting good nutrition

HC level

  • nb of cases screened and cared for severe and moderate AM
  • nb of growth follow-ups

Hospital level

  • nb of treated severe AM cases with complications
  • length of the stay

All hospitals with nutrition services fall under the Nutrition PBF program. At lower levels, only HCs in the intervention group and the CHW that refer to them are subject to the Nutrition PBF.


No Intervention: Control
45 health centres are in the control group. Health centres in this group are not incentivized, but they receive an equivalent funding to the one received by the intervention group. The main difference is that this payment is not based on their own performance.



Primary Outcome Measures :
  1. Change in recovery rate of acute malnutrition in children below five years old over two years [ Time Frame: 26 months from baseline; endline survey in December 2016 ]
    Recovery rate of acute malnutrition in children below five years old is assessed through clinical files of acute malnutrition cases completed during the six-month periods preceding each survey (first wave: clinical files cover the March-August 2014 period; second wave: it covers the May-October 2016 period).

  2. Difference in prevalence of acute malnutrition among children aged 6-23 months between Dec 2014 and Dec 2016 [ Time Frame: Two years from baseline; endline survey in December 2016 ]
    Acute malnutrition is defined as: weight for height z-score<-2 or mid-upper arm circumference<125 mm


Secondary Outcome Measures :
  1. Difference in prevalence of stunting among children aged 6-23 months between Dec 2014 and Dec 2016 [ Time Frame: Two years from baseline; endline survey in December 2016 ]
    Stunting is defined as: height for age z-score<-2

  2. Difference in weight-for-Height Z-score among children aged 6-23 months between Dec 2014 and Dec 2016 [ Time Frame: Two years from baseline; endline survey in December 2016 ]
    The weight for height Z-score expresses the weight for height ratio as a number of standard deviations or Z-scores below or above the reference mean or median value; which here is based on the NCHS/WHO international reference population.



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Ages Eligible for Study:   6 Months to 23 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Living in the catchment area of a health center under the study

Exclusion Criteria:

  • Mother or tutor of the child not available for the survey
  • Head of household or husband of the mother of the child not available for the survey

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02721160


Sponsors and Collaborators
Institute of Tropical Medicine, Belgium
World Bank
Ministry of Health, Burundi
Institut de Statistiques, Burundi (ISTEEBU)
Institut National de Santé Publique, Burundi (INSP)
Investigators
Principal Investigator: Catherine Korachais, PhD Institute of Tropical Medicine of Antwerp, Belgium

Study Data/Documents: Study Protocol  This link exits the ClinicalTrials.gov site

Protocol of the impact evaluation study at the community level (main outcome: prevalence of acute malnutrition among children aged 6-23 months)

IN FRENCH ONLY


Study Protocol  This link exits the ClinicalTrials.gov site

Protocol of the impact evaluation study at the health centre level (main outcome: recovery rate from acute malnutrition, among children below 5 years old)

IN FRENCH ONLY


Concept Note  This link exits the ClinicalTrials.gov site
Initial concept Note of the overall impact evaluation study

Publications:
Institut de Statistiques et d'Études Économiques du Burundi (ISTEEBU), Ministère de la Santé Publique et de la Lutte contre le Sida [Burundi] (MSPLS), and ICF International. 2012. Enquête Démographique et de Santé Burundi 2010 (DHS Burundi 2010, Final Report). Bujumbura, Burundi : ISTEEBU, MSPLS, et ICF International.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Institute of Tropical Medicine, Belgium
ClinicalTrials.gov Identifier: NCT02721160     History of Changes
Other Study ID Numbers: IRB-951/14
First Posted: March 29, 2016    Key Record Dates
Last Update Posted: June 1, 2018
Last Verified: March 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Anonymized data will be owned by the Government of Burundi (precisely: by ISTEEBU for the household data and by INSP for the facility data).

All anonymized data collected for this project (facility and household data) will be made available after the completion of data collection, upon request to the data owners and after the approval of their committee.


Keywords provided by Institute of Tropical Medicine, Belgium:
performance-based financing
malnutrition
impact evaluation

Additional relevant MeSH terms:
Malnutrition
Nutrition Disorders