81311 enGender Impact: The World Bank’s Gender Impact Evaluation Database Effect on Maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation Paulin Basinga, Paul Gertler, Agnes Binagwaho, Agnes Soucat, Jennifer Sturdy, Christel Author(s) Vermeersch Contact gertler@haas.berkeley.edu Country Rwanda Organizing Theme Health Status Completed Intervention Category Pay for Performance Sector Health, Nutrition & Population Abstract No Abstract Gender Connection Gender Focused Intervention Gender Outcomes Sexual, maternal and reproductive health outcomes IE Design Randomized Control Trial In this P4P scheme, payments are made directly to primary health facilities and used at each facility's discretion. Each facility was rated with and index comprised of 14 key maternal Intervention and child health-care output indicators. The size of the payment depends upon the facility's score on the index. The payment of control facilities was increased so that the average payment received by controls equals the average P4P payment in treatment facilities. Intervention Period The program started between June 2006 and October 2006 80 health facilities were treated with P4P while 86 facilities served as control. Additionally, Sample population a household survey was conducted in a total of 2158 households. 13 households from the catchment area of each of the 166 facilities were selected. Health facilities that received P4P were compared to health facilities that did not receive Comparison conditions the program. The control facilities received an increase in funds so that the average funds of treatment was same as the funds for control facilities. Unit of analysis Health facilities Evaluation Period Follow up occurred 25 months after the baseline survey. There was a large and significant increase in the number of institutional deliveries and number of preventative care visits by children. There were no improvements in the number Results of women who completed prenatal care visits or of children receiving full immunization schedules. There is a significant increase in prenatal quality as measured by compliance with Rwandan prenatal care guidelines. The original randomized design was slightly compromised. The study may lack some Primary study limitations external validity because incentive effects for prenatal care may not extend to other Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database services. The World Bank-Netherlands Partnership Program, Spanish Impact Evaluation Fund, the Funding Source British Economic and Social Research Council, Government of Rwanda, Global Development Network Basinga, P., Gertler, P. J., Binagwaho, A., Soucat, A. L., Sturdy, J., & Vermeersch, C. M. (2011). Effect on maternal and child health services in Rwanda of payment to primary Reference(s) health-care providers for performance: an impact evaluation. The Lancet, 377(9775), 1421- 1428. Link to Studies http://www.sciencedirect.com.libproxy- wb.imf.org/science/article/pii/S0140673611601773 Microdata Last updated: 14 August 2013 2