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