Going Beyond Incentivizing Formal Health Providers

Evidence from the Rwanda Community Performance‐based Financing Program

Gil Shapira, Ina Kalisa, Jeanine Condo, James Humuza, Cathy Mugeni, Denis Nkunda, Jeanette Walldorf

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Resumé

Pay‐for‐performance programs are introduced in an increasing number of low‐ and middle‐income countries with the goal of reducing maternal and child mortality and morbidity through increased health service utilization and quality. Although most programs incentivize formal health providers, some constraints to utilization might be better alleviated by incentivizing other actors in the health care system. This paper presents results from a randomized controlled trial set to evaluate the effects of two incentive schemes that were introduced on top of Rwanda's national Performance‐Based Financing program at the health facility level. One scheme rewarded community health worker cooperatives for the utilization of five services by their communities. The second scheme provided in‐kind transfers to users of three services. The analysis finds no impact of the cooperative performance payments on coverage of the targeted services, behaviors of community health workers, or outcomes at the cooperative level. Although health centers experienced frequent stock outs of the gifts, the demand‐side intervention significantly increased timely antenatal care by 9.3 percentage points and timely postnatal care by 8.6 percentage points. This study shows that demand‐side incentives can increase service utilization also when provided in addition to a supply‐side pay‐for‐performance scheme.
OriginalsprogEngelsk
TidsskriftHealth Economics
Vol/bind27
Udgave nummer12
Sider (fra-til)2087-2106
Antal sider20
ISSN1057-9230
DOI
StatusUdgivet - 2018

Emneord

  • Maternal and child health
  • Pay‐for‐performance
  • Rwanda

Citer dette

Shapira, Gil ; Kalisa, Ina ; Condo, Jeanine ; Humuza, James ; Mugeni, Cathy ; Nkunda, Denis ; Walldorf, Jeanette. / Going Beyond Incentivizing Formal Health Providers : Evidence from the Rwanda Community Performance‐based Financing Program. I: Health Economics. 2018 ; Bind 27, Nr. 12. s. 2087-2106.
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abstract = "Pay‐for‐performance programs are introduced in an increasing number of low‐ and middle‐income countries with the goal of reducing maternal and child mortality and morbidity through increased health service utilization and quality. Although most programs incentivize formal health providers, some constraints to utilization might be better alleviated by incentivizing other actors in the health care system. This paper presents results from a randomized controlled trial set to evaluate the effects of two incentive schemes that were introduced on top of Rwanda's national Performance‐Based Financing program at the health facility level. One scheme rewarded community health worker cooperatives for the utilization of five services by their communities. The second scheme provided in‐kind transfers to users of three services. The analysis finds no impact of the cooperative performance payments on coverage of the targeted services, behaviors of community health workers, or outcomes at the cooperative level. Although health centers experienced frequent stock outs of the gifts, the demand‐side intervention significantly increased timely antenatal care by 9.3 percentage points and timely postnatal care by 8.6 percentage points. This study shows that demand‐side incentives can increase service utilization also when provided in addition to a supply‐side pay‐for‐performance scheme.",
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Going Beyond Incentivizing Formal Health Providers : Evidence from the Rwanda Community Performance‐based Financing Program. / Shapira, Gil; Kalisa, Ina; Condo, Jeanine; Humuza, James; Mugeni, Cathy; Nkunda, Denis; Walldorf, Jeanette.

I: Health Economics, Bind 27, Nr. 12, 2018, s. 2087-2106.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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