Assessing implementation fidelity of a results-based financing intervention in Burkina Faso

Implementation fidelity assessment represents a significant piece in the program evaluation puzzle although it is often overlooked. This is particularly the case of results-based financing (RBF) studies where the major part of the attention is taken up by impact studies. However, bending to the exercise of assessing fidelity implementation is essential to go beyond the demonstration of program effectiveness and to better understand the intervention’s foundations. Our study provides an overview of the implementation fidelity of a RBF program in Burkina Faso using one aspect of fidelity: “adherence” to intervention design and its components (content, coverage, temporality). We conducted a case study in three health districts and at different levels of the health system one year after the program was implemented. On the whole, the results show quite good adherence to intervention design without a significant difference between districts. However, the different levels of care demonstrated heterogeneous degrees of fidelity: the community health centres level seems to have encountered particular implementation issues. Moreover, implementation fidelity varies according to the component being discussed: if the programming component (including training and material allocations activities) was relatively faithful to the intervention design, our study shows weak fidelity in three aspects: action research, performance verification and grant payments. This leads to the fact that, at this stage of the program implementation, the financial incentives considered to be at the core of the RBF logic do not reach health staff. Overall, the implementation globally respected the program agenda, even if small delays are sometimes identified.