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Incentivizing Quantity and Quality of Care : Evidence from an Impact Evaluation of Performance-Based Financing in the Health Sector in Tajikistan (English)

This paper presents the results of an impact evaluation of a performance-based financing pilot in rural areas of two regions of Tajikistan. Primary care facilities were given financial incentives conditional on general quality and the quantity provided of selected services related to reproductive, maternal and child health, and hypertension-related services. The study relies on a difference-in-difference design and large-scale household and facility-based surveys conducted before the launch of the pilot in 2015 and after three years of implementation. The performance-based financing pilot had positive impacts on quality of care. Significant impacts are measured on facility infrastructure, infection prevention and control standards, availability of equipment and medical supplies, provider competency, provider satisfaction, and even some elements of the content of care, measured through direct observations of provider-patient interactions. While the communities in the performance-based financing districts reported higher satisfaction with the local primary care facilities, and despite the improvements in quality, the findings suggest moderate effects on utilization: among the incentivized utilization indicators, only timely postnatal care and blood pressure measurements for adults were significantly impacted.


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    Ahmed,Tashrik, Arur,Aneesa, De Walque,Damien B. C. M., Shapira,Gil

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    Policy Research Working Paper

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    Europe and Central Asia,

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    Incentivizing Quantity and Quality of Care : Evidence from an Impact Evaluation of Performance-Based Financing in the Health Sector in Tajikistan

  • Keywords

    maternal and child health services; quality of care; unmet need for family planning; quality of health services; Infection Prevention and Control; standard error; antenatal and postnatal care; baseline survey; primary health-care; millennium development goal; ordinary least squares regression; School of Public Health; availability of family planning; primary health care services; positive impact; health facility; rural health; catchment area; blood pressure; wealth quintile; statistical significance; primary health facility; primary care facilities; pay for performance; quality improvement; health service coverage; development research group; follow up survey; elevated blood pressure; acute respiratory infection; work in past; equipment and supply; citizen scorecards; world development indicator; delivery of health; child health outcomes; volume of services; health care budget; burden of disease; maternal health service; primary care services; public health expenditure; reproductive health service; child growth monitoring; high population density; health system reform; oral contraceptive pill; health seeking behavior; impact on health; disparities in health; oral rehydration solution; average treatment effect; method of contraception; consumption of alcohol; household survey; fixed effect; Health Workers; pregnant woman; test kit; primary level; financial incentive; education level; employment status; cardiovascular risk; coverage rate; clinical observations; rural area; home visit; Antenatal Care; live birth; monthly income; facility management; rural district; malnourished child; noncommunicable diseases; medical supply; household wealth; Essential Drugs; curative care; child vaccination; physical examination; performance incentive; anthropometric measure; health teams; reproductive age; treatment group; risk score; physical activity; basic vaccinations; empirical specification; inpatient service; health results; laboratory services; internal evaluation; estimate impact; health behavior; piped water; medical records; Social Sciences; financial reward; physical condition; consultation time; clinical staff; working condition; improved health; catchment population; health matter; marital status; health program; laboratory testing; measurement tool; general population; health gain; maternity ward; care facility; systematic analysis; universal health; curative consultation; positive coefficient; primary service; household data; disposal procedures; demand-side interventions; study design; summer months; protected springs; dug well; administrative datum; tube wells; public tap; survey methodology; population level; heart disease; clinical guidelines; conversion rate; smaller number; child weight; conceptual framework; vaccination rate; black box; quality service; medical advice; measles vaccine; case management; polio vaccine; examination procedure; pentavalent vaccine; Medical care; medical protocols; long-run effect; economic statistic; clinical presentation; chest pain; external assessment; public policy; counseling service; population health; diagnostic kit; open access; medical guidelines; external supervision; hiv testing; internal administration; Intrauterine Device; Learning and Innovation Credit; development policy; staff retention; patient consultations; geographic location; Civil War; kidney disease; community perceptions; nutrition service; severe dehydration; bottled water; income increase; rubella vaccine; survey design; curative service; performance bonus; diarrhea management; quality indicators; clinical indicator; physical infrastructure; global knowledge; household sample; project finance; children of ages; adult health; district hospital; chemical sterilization; patient records; decontamination procedure; disposal method; behavioral change; chronic disease; prescription drug; survey enumerator; financially support; remote area; life expectancy



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Ahmed,Tashrik Arur,Aneesa De Walque,Damien B. C. M. Shapira,Gil

Incentivizing Quantity and Quality of Care : Evidence from an Impact Evaluation of Performance-Based Financing in the Health Sector in Tajikistan (English). Policy Research working paper,no. WPS 8951,Impact Evaluation series Washington, D.C. : World Bank Group.