Evaluating a health financing policy change: framework and suggested approaches

Abstract

Immpact is a global research initiative which seeks to strengthen the evidence base for policy decision-makers on cost-effective intervention strategies to reduce maternal mortality. Immpact has been working in partnership with local stakeholders to identify and evaluate strategies with the potential for significantly reducing maternal and perinatal mortality. In Ghana, one of the focus countries for the first phase , the government policy of providing free deliveries for all women was selected for evaluation through a consultative process. The aim of the overall Immpact evaluation was to assess how the free delivery policy had affected utilization, quality of services and health and non-health outcomes for households (NMIMR and Immpact, 2005). Tools were developed and fieldwork began in 2005, leading to an evaluation report in 2006 (Armar-Klemesu et al, 2006). Although the evaluation focused on a specific policy and evaluated the policy from the point of view of maternal health, the approach used was one which is of wider relevance to any situation where the health financing burden is being changed. It was decided therefore that this technical paper should be produced, describing the evaluation framework and the specific tools and approaches used, together with the experience of using them. These tools are intended to assist researchers looking at related questions in future. All the tools require adaptation to different contexts, but the examples may at least serve as a starting point for other evaluations. Within Immpact, the approach described in this document has already been adapted twice - once for an evaluation of a cost-sharing scheme for maternal health in Nepal (ICH, SSMP, & Immpact, 2006), and again for an evaluation of a free delivery and Caesarean policy in Senegal (MoH et al, 2006). Two of the approaches discussed in this paper were also used in relation to different evaluation questions in Indonesia and Burkina Faso, and these experiences will be reflected.