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The effects of performance incentives on the utilization and quality of maternal and child care in Burundi

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  • Bonfrer, Igna
  • Van de Poel, Ellen
  • Van Doorslaer, Eddy

Abstract

Africa's progress towards the health related Millennium Development Goals remains limited. This can be partly explained by inadequate performance of health care providers. It is therefore critical to incentivize this performance. Payment methods that reward performance related to quantity and quality, called performance based financing (PBF), have recently been introduced in over 30 African countries. While PBF meets considerable enthusiasm from governments and donors, the evidence on its effects is still limited. In this study we aim to estimate the effects of PBF on the utilization and quality of maternal and child care in Burundi. We use the 2010 Burundi Demographic and Health Survey (August 2010–January 2011, n = 4916 women) and exploit the staggered rollout of PBF between 2006 and 2010, to implement a difference-in-differences approach. The quality of care provided during antenatal care (ANC) visits improved significantly, especially among the better off, although timeliness and number of ANC visits did not change. The probability of an institutional delivery increased significantly with 4 percentage points among the better off but no effects were found among the poor. PBF does significantly increase this probability (with 5 percentage points) for women where PBF was in place from the start of their pregnancy, suggesting that women are encouraged during ANC visits to deliver in the facility. PBF also led to a significant increase of 4 percentage points in the probability of a child being fully vaccinated, with effects more pronounced among the poor. PBF improved the utilization and quality of most maternal and child care, mainly among the better off, but did not improve targeting of unmet needs for ANC. Especially types of care which require a behavioral change of health care workers when the patient is already in the clinic show improvements. Improvements are smaller for services which require effort from the provider to change patients' utilization choices.

Suggested Citation

  • Bonfrer, Igna & Van de Poel, Ellen & Van Doorslaer, Eddy, 2014. "The effects of performance incentives on the utilization and quality of maternal and child care in Burundi," Social Science & Medicine, Elsevier, vol. 123(C), pages 96-104.
    • Handle: RePEc:eee:socmed:v:123:y:2014:i:c:p:96-104
    DOI: 10.1016/j.socscimed.2014.11.004
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    1. Laurence Lannes & Bruno Meessen & Agnes Soucat & Paulin Basinga, 2016. "Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(3), pages 309-348, July.
    2. 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.
    3. 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.
    4. Lannes, Laurence, 2015. "Improving health worker performance: The patient-perspective from a PBF program in Rwanda," Social Science & Medicine, Elsevier, vol. 138(C), pages 1-11.
    5. Ellen Van de Poel & Gabriela Flores & Por Ir & Owen O'Donnell, 2016. "Impact of Performance‐Based Financing in a Low‐Resource Setting: A Decade of Experience in Cambodia," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 688-705, June.
    6. Peter Binyaruka & Edith Patouillard & Timothy Powell-Jackson & Giulia Greco & Ottar Maestad & Josephine Borghi, 2015. "Effect of Paying for Performance on Utilisation, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-16, August.
    7. Lohmann, Julia & Houlfort, Nathalie & De Allegri, Manuela, 2016. "Crowding out or no crowding out? A Self-Determination Theory approach to health worker motivation in performance-based financing," Social Science & Medicine, Elsevier, vol. 169(C), pages 1-8.
    8. Fichera, Eleonora & Anselmi, Laura & Gwati, Gwati & Brown, Garrett & Kovacs, Roxanne & Borghi, Josephine, 2021. "Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe," Social Science & Medicine, Elsevier, vol. 279(C).
    9. 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.
    10. 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.
    11. Duchoslav, Jan & Cecchi, Francesco, 2019. "Do incentives matter when working for god? The impact of performance-based financing on faith-based healthcare in Uganda," World Development, Elsevier, vol. 113(C), pages 309-319.
    12. Falisse, Jean-Benoit & Ntakarutimana, Léonard, 2020. "When information is not power: Community-elected health facility committees and health facility performance indicators," Social Science & Medicine, Elsevier, vol. 265(C).
    13. Martin Chalkley & Andrew J. Mirelman & Luigi Siciliani & Marc Suhrcke & Peter Berman, 2020. "Paying for Performance for Health Care in Low- and Middle-Income Countries: An Economic Perspective," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 6, pages 157-190, World Scientific Publishing Co. Pte. Ltd..
    14. Jobiba Chinkhumba & Manuela De Allegri & Jacob Mazalale & Stephan Brenner & Don Mathanga & Adamson S Muula & Bjarne Robberstad, 2017. "Household costs and time to seek care for pregnancy related complications: The role of results-based financing," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-18, September.
    15. Laura Anselmi & Julius Ohrnberger & Eleonora Fichera & Pedroso Nhassengo & Quinhas F. Fernandes & Sergio Chicumbe, 2023. "The impact of performance‐based financing within local health systems: Evidence from Mozambique," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1525-1549, July.
    16. Elisabeth Paul & Oriane Bodson & Valéry Ridde, 2021. "What theories underpin performance-based financing? A scoping review," ULB Institutional Repository 2013/318091, ULB -- Universite Libre de Bruxelles.
    17. Manassé Nimpagaritse & Catherine Korachais & Bruno Meessen, 2020. "Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnut," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-25, January.
    18. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
    19. Mayumana, Iddy & Borghi, Jo & Anselmi, Laura & Mamdani, Masuma & Lange, Siri, 2017. "Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania," Social Science & Medicine, Elsevier, vol. 179(C), pages 61-73.
    20. Amira El-Shal & Patricia Cubi-Molla & Mireia Jofre-Bonet, 2023. "Discontinuation of performance-based financing in primary health care: impact on family planning and maternal and child health," International Journal of Health Economics and Management, Springer, vol. 23(1), pages 109-132, March.
    21. Maria Paola Bertone & Jean-Benoît Falisse & Giuliano Russo & Sophie Witter, 2018. "Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-27, April.

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