Action research on health financing in Senegal


From 5 – 13 October, KIT advisors Jurrien Toonen and Christel Jansen visited Dakar, Kaolack and Kaffrine in Senegal, to begin the action research on enhancing the quality of care checklists in Senegal’s Results-Based Financing Program. The action research will take until June 2016.

Results-Based Financing in Senegal

Senegal’s Ministry of Health and Social Affairs (MOH) began piloting a Results-Based Financing (RBF) program in two regions, Kaffrine and Kolda in 2012 and has since expanded the program to an additional four regions, with the intent eventually to implement RBF nationwide. The RBF program rewards the performance of health posts and centers on the basis of meeting quantitative targets  for certain priority programs. This score is adjusted for a quality rating. At the hospital level, currently only quantitative targets are being used.

The question

The RBF program would like to improve how it accounts for quality now, apply a similar method to reward better quality in hospitals, and learn how it can complement the RBF checklists to obtain even better quality performance from providers.

The project: enhancing quality of care through RBF in Senegal

In the coming months, a consortium of KIT and Results for Development Institute (R4D) from Washington, will support the MOH in strengthening the quality of care mechanism in Senegal’s RBF program through:

  • Improve the existing quality checklists and how they are applied at the health center and health post levels;
  • Assist the RBF program with the development and subsequent pilot implementation of a hospital quality checklist;
  • Discover how the quality response to RBF might be enhanced by digging into the “black box” of how provider personnel react to the quality checklists;
  • Formulate recommendations concerning the quality mechanism for the continuing national roll out of the RBF program of Senegal;
  • Contribute to national and international knowledge about quality assessment mechanisms (specifically for EONC) in RBF programs.

Basic principle in Results Based Financing is that providers are held to account on results – this is applied in quantitative results (e.g. number of deliveries, etc.) – but when RBF turns to quality of care, providers are held to account on “structure” (availability of equipment, etc.) not on “results in QC” (like if patients received oxytocin immediately after delivery). This study is adding “process” and “results” indicators to “structure” indicators – but results that providers can be held to account. It is a type of action-research or intervention-research: an intervention is developed with those responsible for implementation at central level as well as at operational level. Quantitative and qualitative research methods are used for ongoing analysis of whether the intervention works or not (mainly quantitative information), and if so what, why and how (mainly qualitative information).

The action research is funded through the USAID TRAction (Translating Reserach into Action) program, that supports action research into quality and performance-based financing (another term for RBF); with a focus on essential obstetric and newborn care (EONC). The consortium is led by R4D.

The first week

The R4D/KIT team met with key stakeholders to confirm the objectives and intended outputs of the work, received a briefing from MOH and the World Bank on the current status of RBF scale-up and discussed how to align TRAction’s work, and obtained buy-in for and consensus on a field data collection plan and project calendar. We also received input from MOH and partners on the modification of the RBF program’s primary-level checklists, the development of a secondary-level checklist, and the data collection methodology and instruments for the “black box” study of provider behavior change in response to quality incentives. Subsequently, an initial field test of the data collection questionnaires for the primary-level quality checklists and the black box study took place in Kaffrine.

Would you like to read more about KIT’s work in this field? Visit our themepage on results based financing