Paying Primary Health Care Centers for Performance in Rwanda

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.

Bibliographic Details

Main Authors:	Basinga, Paulin, Gertler, Paul J., Soucat, Agnes L.B., Binagwaho, Agnes, Sturdy, Jennifer R., Vermeersch, Christel M.J.
Language:	English en_US
Published:	World Bank, Washington, DC 2010-01
Subjects:	ALCOHOL, ALCOHOL USE, ANEMIA, ANTENATAL CARE, BLEEDING, BODY WEIGHT, CHILD GROWTH MONITORING, CHILD HEALTH, CHILD HEALTH CARE, CHILD HEALTH SERVICES, CHILD SURVIVAL, CHILDBIRTH, CLEANLINESS, CLINICAL PRACTICE, CLINICS, COMMUNITY HEALTH, COMMUNITY HEALTH WORKERS, CONTRACEPTIVE USE, CONTRACEPTIVE USERS, DEVELOPING COUNTRIES, DIABETES, DISTRICT HOSPITAL, DRUGS, EMPOWERING WOMEN, EXPENDITURES, FAMILIES, FAMILY MEMBERS, FAMILY PLANNING, FINANCIAL MANAGEMENT, GENOCIDE, GLOBAL DEVELOPMENT, GLOBAL HEALTH, GOITER, GONORRHEA, GRID, HEALTH BEHAVIOR, HEALTH CARE CENTERS, HEALTH CARE SERVICES, HEALTH CENTERS, HEALTH CENTRES, HEALTH FACILITIES, HEALTH FACILITY, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INTERVENTIONS, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROBLEMS, HEALTH SERVICES, HEALTH SYSTEM, HEALTH WORKERS, HEART DISEASE, HIGH BLOOD PRESSURE, HIV, HOSPITAL, HOSPITALS, HUMAN DEVELOPMENT, IMMUNIZATION, INCOME, INFANT, INFANT MORTALITY, INFANTS, INFORMED CONSENT, INTERVENTION, LAB TESTS, LABORATORY SERVICES, LAND OWNERSHIP, LOW BIRTH WEIGHT, LOW-INCOME COUNTRIES, MALARIA, MALARIA PROPHYLAXIS, MALNOURISHED CHILDREN, MARITAL STATUS, MATERNAL AND CHILD HEALTH, MATERNAL CARE, MATERNAL HEALTH, MATERNAL HEALTH SERVICES, MATERNAL MORTALITY, MEDICAL CARE, MEDICAL DOCTORS, MEDICAL PERSONNEL, MEDICAL SUPPLIES, MINISTRY OF HEALTH, MISCARRIAGES, MORBIDITY, MORTALITY, MOSQUITO NETS, MOTHER, NATIONAL HEALTH, NAUSEA, NEWBORN, NUMBER OF CHILDREN, NURSES, NUTRITION, OBSTETRIC CARE, OFFICIAL DEVELOPMENT ASSISTANCE, PAP SMEAR, PATIENT, PATIENTS, PHARMACY, PHYSICAL EXAMINATIONS, PHYSICIAN, PHYSICIANS, POLICY IMPLICATIONS, POLICY RESEARCH, POLICY RESEARCH WORKING PAPER, POPULATION DENSITY, POSTNATAL CARE, PREGNANCIES, PREGNANCY, PREGNANT WOMEN, PRENATAL CARE, PRENATAL CARE UTILIZATION, PREVENTIVE HEALTH, PREVENTIVE HEALTH CARE, PRIMARY CARE, PRIMARY EDUCATION, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE FACILITIES, PROBABILITY, PROGRESS, PROPHYLAXIS, PUBLIC HEALTH, QUALITY CARE, QUALITY OF CARE, QUALITY OF HEALTH, QUALITY OF SERVICES, RATES OF GROWTH, REDUCING MATERNAL MORTALITY, RISK PREGNANCIES, RURAL AREAS, SAFE MOTHERHOOD, SERVICE DELIVERY, SERVICE PROVISION, SEX, SKILLED ATTENDANCE, SKILLED ATTENDANCE AT DELIVERY, SKILLED ATTENDANTS, SOCIAL RESEARCH, SOCIOECONOMIC STATUS, STD, STIS, SYMPTOMS, SYPHILIS, TETANUS, TOBACCO, TREATMENT, TROPICAL MEDICINE, TUBERCULOSIS, VACCINATION, VACCINATION CAMPAIGN, VACCINE, VACCINES, VITAL SIGNS, VOMITING, WOMAN, WORKERS, YOUNG CHILDREN,
Online Access:	http://documents.worldbank.org/curated/en/2010/01/11696987/paying-primary-health-care-centers-performance-rwanda https://hdl.handle.net/10986/19900
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