Qualitative Supplement to IMATCHINE Project
The IMATCHINE project is an evaluation of ongoing voucher and conditional cash transfer programs for obstetric care in the private sector, in Gujarat and Karnataka respectively, using quasi-experimental and experimental research designs to understand the impact of these subsidy programs on utilization of services and also on health outcomes. The project also includes a large cluster randomized trial, in Karnataka, of supply side incentives for providers based on improvements in quality of care or improvements in population health outcomes.
While the quantitative evaluation will focus on estimating the impact of the financial incentives on obstetric and neonatal outcomes, the qualitative component aims to inform the mechanisms through which these impacts might be driven. The qualitative research components will help answer the following broad questions:
1. What motivates private-sector providers of Ob-Gyn services in rural Karnataka to do their routine work in the first place?
2. How do the motivating factors inform the development of non-financial incentives?
3. How are financial incentives going to play out in light of these motivating factors?
4. What do providers do to improve quality of care or improve population health outcomes in response to financial and non-financial incentives?
A critical piece of this study aims to understand how the practices of private-sector providers have changed after the introduction of supply-side financial and non-financial incentives as part of the IMATCHINE cluster randomized experiment. Examples of questions of interest include: What have providers actually done in order to deliver demonstrably higher quality results? What accountability mechanisms, formal or informal, are involved in these modes of service delivery? What types of intermediaries, if any, are involved?