Going beyond incentivizing formal health providers: Evidence from the Rwanda Community Performance-Based Financing program

Health Economics
Gil ShapiraJeanette Walldorf

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 sho...Continue Reading

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Citations

Apr 18, 2019·The International Journal of Health Planning and Management·Naasegnibe KuunibeManuela De Allegri
May 6, 2021·The Cochrane Database of Systematic Reviews·Karin DiaconuSophie Witter
Oct 14, 2021·Health Research Policy and Systems·Maryse KokHenry B Perry

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