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Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation

Summary Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and mate... Full description

Journal Title: The Lancet (British edition) 2011, Vol.377 (9775), p.1421-1428
Main Author: Basinga, Paulin, PhD
Other Authors: Gertler, Paul J, Prof , Binagwaho, Agnes, MMed , Soucat, Agnes LB, MMed , Sturdy, Jennifer, MA , Vermeersch, Christel MJ, PhD
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
format: Article
creator:
  • Basinga, Paulin, PhD
  • Gertler, Paul J, Prof
  • Binagwaho, Agnes, MMed
  • Soucat, Agnes LB, MMed
  • Sturdy, Jennifer, MA
  • Vermeersch, Christel MJ, PhD
subjects:
  • Abridged Index Medicus
  • Adult
  • Biological and medical sciences
  • Child Health Services - economics
  • Child Health Services - utilization
  • Child, Preschool
  • Children & youth
  • Clinical medicine
  • Data collection
  • Delivery, Obstetric - economics
  • Delivery, Obstetric - statistics & numerical data
  • Demographic aspects
  • Developing Countries
  • Female
  • General aspects
  • Health care access
  • Health facilities
  • Health Facilities - economics
  • Health Facilities - utilization
  • Health participants
  • Health services
  • Hospitals
  • Humans
  • Incentives
  • Infant
  • Internal Medicine
  • LDCs
  • Management
  • Maternal & child health
  • Maternal Health Services - economics
  • Maternal Health Services - utilization
  • Medical sciences
  • Medical supplies
  • Monitoring systems
  • Mortality
  • Outcome Assessment (Health Care)
  • Pay for performance
  • Pregnancy
  • Prenatal Care
  • Preventive Health Services - economics
  • Preventive Health Services - utilization
  • Primary nursing
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Quality Indicators, Health Care
  • Quality of Health Care
  • Reimbursement, Incentive
  • Rwanda
  • Studies
  • Usage
ispartof: The Lancet (British edition), 2011, Vol.377 (9775), p.1421-1428
description: Summary Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. Methods 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Findings Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. Interpretation The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Funding World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluati
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
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titleEffect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
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creatorBasinga, Paulin, PhD ; Gertler, Paul J, Prof ; Binagwaho, Agnes, MMed ; Soucat, Agnes LB, MMed ; Sturdy, Jennifer, MA ; Vermeersch, Christel MJ, PhD
creatorcontribBasinga, Paulin, PhD ; Gertler, Paul J, Prof ; Binagwaho, Agnes, MMed ; Soucat, Agnes LB, MMed ; Sturdy, Jennifer, MA ; Vermeersch, Christel MJ, PhD
descriptionSummary Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. Methods 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Findings Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. Interpretation The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Funding World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
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languageeng
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subjectAbridged Index Medicus ; Adult ; Biological and medical sciences ; Child Health Services - economics ; Child Health Services - utilization ; Child, Preschool ; Children & youth ; Clinical medicine ; Data collection ; Delivery, Obstetric - economics ; Delivery, Obstetric - statistics & numerical data ; Demographic aspects ; Developing Countries ; Female ; General aspects ; Health care access ; Health facilities ; Health Facilities - economics ; Health Facilities - utilization ; Health participants ; Health services ; Hospitals ; Humans ; Incentives ; Infant ; Internal Medicine ; LDCs ; Management ; Maternal & child health ; Maternal Health Services - economics ; Maternal Health Services - utilization ; Medical sciences ; Medical supplies ; Monitoring systems ; Mortality ; Outcome Assessment (Health Care) ; Pay for performance ; Pregnancy ; Prenatal Care ; Preventive Health Services - economics ; Preventive Health Services - utilization ; Primary nursing ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality Indicators, Health Care ; Quality of Health Care ; Reimbursement, Incentive ; Rwanda ; Studies ; Usage
ispartofThe Lancet (British edition), 2011, Vol.377 (9775), p.1421-1428
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0Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
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descriptionSummary Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. Methods 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Findings Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. Interpretation The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Funding World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
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7Clinical medicine
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9Delivery, Obstetric - economics
10Delivery, Obstetric - statistics & numerical data
11Demographic aspects
12Developing Countries
13Female
14General aspects
15Health care access
16Health facilities
17Health Facilities - economics
18Health Facilities - utilization
19Health participants
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22Humans
23Incentives
24Infant
25Internal Medicine
26LDCs
27Management
28Maternal & child health
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31Medical sciences
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33Monitoring systems
34Mortality
35Outcome Assessment (Health Care)
36Pay for performance
37Pregnancy
38Prenatal Care
39Preventive Health Services - economics
40Preventive Health Services - utilization
41Primary nursing
42Public health. Hygiene
43Public health. Hygiene-occupational medicine
44Quality Indicators, Health Care
45Quality of Health Care
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48Studies
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titleEffect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
authorBasinga, Paulin, PhD ; Gertler, Paul J, Prof ; Binagwaho, Agnes, MMed ; Soucat, Agnes LB, MMed ; Sturdy, Jennifer, MA ; Vermeersch, Christel MJ, PhD
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1Adult
2Biological and medical sciences
3Child Health Services - economics
4Child Health Services - utilization
5Child, Preschool
6Children & youth
7Clinical medicine
8Data collection
9Delivery, Obstetric - economics
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11Demographic aspects
12Developing Countries
13Female
14General aspects
15Health care access
16Health facilities
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46Reimbursement, Incentive
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abstractSummary Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. Methods 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Findings Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. Interpretation The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Funding World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
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