Impact Evaluation of Nigeria State Health Investment Project

In response to slow progress in improving health service delivery, the Government of Nigeria requested World Bank support in testing performance-based financing (PBF) and decentralized facility financing (DFF) as part of the Nigeria State Health Investment Project (NSHIP). PBF provides funding directly to health facilities based on the quantity and quality of services they deliver. Funds are transferred electronically to each facility’s bank account and they have substantial autonomy in how they use the funds. Up to half the funds can be used to pay performance bonuses to staff. Supervision was substantially strengthened. DFF was similar to PBF except that facility earnings were NOT based on the quantity and quality of services they delivered, they could not pay performance bonuses to health workers and the amount they received was, by design, half the amount earned by PBF facilities. This paper reports an impact evaluation (IE) of the PBF-DFF pilot.