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

Health Econ 2018 12 29;27(12):2087-2106. Epub 2018 Aug 29.

Copenhagen Business School, Frederiksberg, Denmark.

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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Source
http://doi.wiley.com/10.1002/hec.3822
Publisher Site
http://dx.doi.org/10.1002/hec.3822DOI Listing
December 2018
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References

(Supplied by CrossRef)
Systematic Review: The use of vouchers for reproductive health services in developing countries: Systematic review
Bellows et al.
Tropical Medicine & International Health 2010
Balancing workload, motivation and job satisfaction in Rwanda: Assessing the effect of adding family planning service provision to community health worker duties
Chin-Quee et al.
Reproductive Health 2016

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