Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impacts

developing a provider incentive payment scheme for Tuberculosis (as a pilot intervention) and will generate evidence on its effects on adherence and treatment success rates and costs. The study will start with the problem conceptualization and the intervention design in collaboration with the policy makers at the national level. The research will seek to answer the following research questions: (1) What is the impact of provider-focused Results Based Financing (RBF) on patients' adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible (DS) and Multi Drug Resistant (MDR) patients in Georgia? The impact of RBF will be evaluated using a quasi-experimental trial design. Eligible facilities will be randomly selected in 20 districts, then randomly allocated to intervention and control groups. The study population will include nurses and physicians involved in TB primary care and TB patients (DS & MDR-TB cases), who provide TB treatment to approximately 500 patients, which represents 12% of the expected total newly registered TB patients. The intervention will be RBF with provider incentives, complementing the existing patients' incentives. The comparison will be of intervention (RBF) and control groups (existing funding model), considering the variety of the contexts (e.g. semi-urban/urban, and public/private facilities). The outcome measures will be adherence to TB treatment and treatment success rate. (2) Is the RBF intervention cost-effective? Cost-effectiveness analysis will generate evidence on the costs of the intervention by comparing the existing model with the added supply side RBF intervention. (3) How does it work, for whom and in which conditions? and (4) How should RBF be modified to optimize national roll-out for this and possibly other health services? To identify the mechanisms of change and the context factors that enhance or undermine the effectiveness of the RBF intervention, will be carried out realist case studies in a sub-set of sites. This theory-informed trial design will allow assessing how and why the RBF scheme leads to the observed results.