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

Autor: Shapira G; Development Research Group, The World Bank, Washington, DC., Kalisa I; School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda., Condo J; Rwanda Biomedical Center, Kigali, Rwanda., Humuza J; School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda., Mugeni C; Ministry of Health, Kigali, Rwanda., Nkunda D; Ministry of Health, Kigali, Rwanda., Walldorf J; Copenhagen Business School, Frederiksberg, Denmark.
Jazyk: angličtina
Zdroj: Health economics [Health Econ] 2018 Dec; Vol. 27 (12), pp. 2087-2106. Date of Electronic Publication: 2018 Aug 29.
DOI: 10.1002/hec.3822
Abstrakt: 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.
(© 2018 The World Bank. Health Economics © 2018 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
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