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Paying primary health care centers for performance in Rwanda

Author

Listed:
  • Basinga, Paulin
  • Gertler, Paul J.
  • Binagwaho, Agnes
  • Soucat, Agnes L.B.
  • Sturdy, Jennifer R.
  • Vermeersch, Christel M.J.

Abstract

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities'input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.

Suggested Citation

  • Basinga, Paulin & Gertler, Paul J. & Binagwaho, Agnes & Soucat, Agnes L.B. & Sturdy, Jennifer R. & Vermeersch, Christel M.J., 2010. "Paying primary health care centers for performance in Rwanda," Policy Research Working Paper Series 5190, The World Bank.
  • Handle: RePEc:wbk:wbrwps:5190
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    Cited by:

    1. Guariso, Andrea & Verpoorten, Marijke, 2015. "Aid, Trad and Post-War Recovery of the Rwandan Coffee Sector," 2015 Conference, August 9-14, 2015, Milan, Italy 211693, International Association of Agricultural Economists.
    2. Julian Cristia & William Evans & Beomsoo Kim, 2011. "Does Contracting-Out Primary Care Services Work? The Case of Rural Guatemala," Research Department Publications 4728, Inter-American Development Bank, Research Department.
    3. Gentilini, Ugo & Omamo, Steven Were, 2011. "Social protection 2.0: Exploring issues, evidence and debates in a globalizing world," Food Policy, Elsevier, vol. 36(3), pages 329-340, June.
    4. Khim, Keovathanak & Annear, Peter Leslie, 2013. "Strengthening district health service management and delivery through internal contracting: Lessons from pilot projects in Cambodia," Social Science & Medicine, Elsevier, vol. 96(C), pages 241-249.
    5. Adrien Renaud & Jean-Paul Semasaka, 2014. "Rwanda," World Bank Other Operational Studies 25127, The World Bank.
    6. World Bank, 2010. "Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector," World Bank Other Operational Studies 2838, The World Bank.
    7. Dominic Haazen, 2012. "Making Health Financing Work for Poor People in Tanzania," World Bank Publications, The World Bank, number 2240, April.
    8. Hong Wang & Kimberly Switlick & Christine Ortiz & Beatriz Zurita & Catherine Connor, 2012. "Health Insurance Handbook : How to Make It Work," World Bank Publications, The World Bank, number 5913, April.
    9. Cristia, Julian & Prado, Ariadna GarcĂ­a & Peluffo, Cecilia, 2015. "The Impact of Contracting in and Contracting out Basic Health Services: The Guatemalan Experience," World Development, Elsevier, vol. 70(C), pages 215-227.
    10. Devarajan, Shantayanan & Kanbur, Ravi, 2013. "The Evolution of Development Strategy as Balancing Market and Government Failure," Working Papers 180091, Cornell University, Department of Applied Economics and Management.

    More about this item

    Keywords

    Health Monitoring&Evaluation; Population Policies; Health Systems Development&Reform; Disease Control&Prevention; Adolescent Health;

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