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Using provider performance incentives to increase HIV testing and counseling services in Rwanda


  • de Walque, Damien
  • Gertler, Paul J
  • Bautista-Arredondo, Sergio
  • Kwan, Ada
  • Vermeersch, Christel
  • de Dieu Bizimana, Jean
  • Binagwaho, Agnes
  • Condo, Jeanine


Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive.

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  • de Walque, Damien & Gertler, Paul J & Bautista-Arredondo, Sergio & Kwan, Ada & Vermeersch, Christel & de Dieu Bizimana, Jean & Binagwaho, Agnes & Condo, Jeanine, 2013. "Using provider performance incentives to increase HIV testing and counseling services in Rwanda," Policy Research Working Paper Series 6364, The World Bank.
  • Handle: RePEc:wbk:wbrwps:6364

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    References listed on IDEAS

    1. A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2011. "Robust Inference With Multiway Clustering," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 29(2), pages 238-249, April.
    2. Scott, A & Schurer, S & Jensen, P H & Sivey, P, 2008. "The Effects of Financial Incentives on Quality of Care: The Case of Diabetes," Health, Econometrics and Data Group (HEDG) Working Papers 08/15, HEDG, c/o Department of Economics, University of York.
    3. Benjamin A. Olken & Junko Onishi & Susan Wong, 2012. "Should Aid Reward Performance? Evidence from a Field Experiment on Health and Education in Indonesia," NBER Working Papers 17892, National Bureau of Economic Research, Inc.
    4. Miller, Grant & Luo, Renfu & Zhang, Linxiu & Sylvia, Sean & Shi, Yaojiang & Foo, Patricia & Zhao, Qiran & Martorell, Reynaldo & Medina, Alexis & Rozelle, Scott, 2012. "Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial," EconStor Open Access Articles, ZBW - Leibniz Information Centre for Economics, pages 1-10.
    5. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
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    Cited by:

    1. Singh, Prakarsh & Mitra, Sandip, 2017. "Incentives, information and malnutrition: Evidence from an experiment in India," European Economic Review, Elsevier, vol. 93(C), pages 24-46.
    2. Lina Maria Ellegård & Jens Dietrichson & Anders Anell, 2018. "Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 39-54, January.
    3. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    4. Xiaojie Sun & Xiaoyun Liu & Qiang Sun & Winnie Yip & Adam Wagstaff & Qingyue Meng, 2016. "The Impact of a Pay‐for‐Performance Scheme on Prescription Quality in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 706-722, June.
    5. Singh, Prakarsh & Masters, William A., 2017. "Impact of caregiver incentives on child health: Evidence from an experiment with Anganwadi workers in India," Journal of Health Economics, Elsevier, vol. 55(C), pages 219-231.
    6. Abbott, Pamela & Sapsford, Roger & Binagwaho, Agnes, 2017. "Learning from Success: How Rwanda Achieved the Millennium Development Goals for Health," World Development, Elsevier, vol. 92(C), pages 103-116.
    7. Tisamarie B. Sherry & Sebastian Bauhoff & Manoj Mohanan, 2017. "Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda," American Journal of Health Economics, MIT Press, vol. 3(2), pages 192-226, Spring.
    8. Jacky MATHONNAT & Aurore PELISSIER, 2017. "How a Results-Based Financing approach can contribute to the health Sustainable Development Goals - Policy-oriented lessons: what we know, what we need to know and don’t yet know," Working Papers P204, FERDI.
    9. Gil Shapira & Ina Kalisa & Jeanine Condo & James Humuza & Cathy Mugeni & Denis Nkunda & Jeanette Walldorf, 2018. "Going beyond incentivizing formal health providers: Evidence from the Rwanda Community Performance‐Based Financing program," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 2087-2106, December.
    10. Bernal, Pedro & Martinez, Sebastian, 2020. "In-kind incentives and health worker performance: Experimental evidence from El Salvador," Journal of Health Economics, Elsevier, vol. 70(C).
    11. Martinez, Sebastian & Bernal, Pedro, 2020. "In-Kind Incentives and Health Worker Performance: Experimental Evidence from El Salvador," IDB Publications (Working Papers) 45, Inter-American Development Bank.

    More about this item


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

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

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