Publication: Can Bonus Payments Improve the Quality of Health Care?
Loading...
Published
2011-05
ISSN
Date
2012-08-13
Author(s)
Editor(s)
Abstract
The goal was to see whether linking bonus payments to performance had a positive effect. Rwanda, which was forced to rebuild its institutions after the 1994 civil war and genocide, began piloting programs in 2001 to give health clinics cash bonuses for meeting certain healthcare objectives, such as immunizing children, and for encouraging people to utilize medical services, such as having pregnant women deliver in a medical facility. Rwanda's health outcomes in the areas of mother-child healthcare ranked among the worst for countries in eastern and southern Africa and the pro programs were an attempt to ensure that people, especially women and children, could get the care they needed to stay healthy.
Link to Data Set
Citation
“World Bank. 2011. Can Bonus Payments Improve the Quality of Health Care?. From Evidence to Policy; No. 6. © World Bank. http://hdl.handle.net/10986/10448 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication Kenya(Washington, DC, 2022-10)Before the COVID pandemic, more than half of children in low and middle-income countries suffered from learning poverty: they either were out of school or failed to learn to read with comprehension by age 10. At the same time, numerous studies have documented serious challenges related to the quality of education services, particularly for those serving poor students. In a country like Kenya, for example, teachers exhibit low levels of content and pedagogical knowledge. Previous research has shown that highly structured teaching guides could improve literacy, but scripted lessons are not without critics, who worry that teachers will not be able to adapt content to student’s needs. In places where teachers may be less prepared to tailor high quality lessons to their students, however, scripting may offer a way to standardize a minimum level of quality at scale.Publication India(World Bank, Washington, DC, 2021-07)In the first years of life, all children need healthy food, a clean environment, and stimulation to thrive and reach their full developmental potential. However, poverty prevents millions of young children in low- and middle-income countries from receiving adequate nutrition and stimulation. As a result, many disadvantaged children’s brain development lags behind that of their well-off peers, which can have lifelong consequences. Previous research from low-income settings has found that encouraging parents to play and interact more with their children can improve children’s brain development, with impacts that can last into adulthood. Delivering these parenting programs at scale and in a cost-effective manner, however, has been a challenge, in part because some of the most successful programs have been delivered through intensive and relatively costly home-based programs.Publication Rwanda(World Bank, Washington, DC, 2021-11)Children need a safe, nurturing, healthy, and stimulating environment to thrive and reach their full potential. But millions of children living in poverty don’t receive enough stimulation or good nutrition in their first years of life, and poverty also makes them more likely to experience neglect and violence in the home. Domestic violence, however, is rarely addressed in programs promoting young children’s development, which also typically focus on mothers, with little attention on fathers. Previous research suggests home-based parenting programs can lead to positive improvements in children’s brain development. Can these programs be adapted to address family violence as well Can these services be effectively delivered through government social safety net programs which often target poor, vulnerable familiesPublication Armenia(World Bank, Washington, DC, 2021-04)More people around the world are dying from noncommunicable diseases than ever before. These diseases, which include cancer, chronic respiratory diseases, diabetes, and heart disease, prematurely kill more than 15 million people between ages 30 and 69 each year. Many of these health conditions also make individuals more susceptible to severe forms of other diseases like Coronavirus disease 2019 (COVID-19). This study targeted adults between the ages of 35 and 68 in Armenia who had not been screened in the preceding year. The baseline data suggests this population was not economically secure: half of participants responded that their income was sufficient for basic family needs, such as food, clothing, and utilities, but not enough for big purchases like a car, while 35 percent responded that their income is sufficient for everyday food but not for clothes and other basic needs. More than half of those in the study were unemployed. This research finds that conditional incentives and personalized invitations can substantially increase screening for diabetes and hypertension for those who haven’t been recently screened. Further research may be needed to evaluate these interventions at scale.Publication Philippines(World Bank, Washington, DC, 2020-11)The World Bank’s Strategic Impact Evaluation Fund supported a randomized controlled trial from 2015-2018 to assess the extent to which subsidized microloans can enable households to build and use improved toilets. The loans, which carried zero interest, included toilet installation and were offered to poor beneficiaries who also received sanitation behavior change promotion as part of a social safety net program. The large financial subsidy led to modestly higher coverage of improved toilets, better toilet quality, and greater satisfaction, while the small subsidy did not improve access to improved sanitation. Among those who took out the subsidized loans, 59 percent already had improved toilets, which explains the limited effects on improved sanitation and open defecation. Overall, these findings suggest that subsidy programs hold promise, but need to be better targeted.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Rwanda(Washington, DC, 2013-03)Ensuring that women and children receive quality health care is a key to alleviating poverty, but in many developing countries, access to appropriate medical care is limited. In recent years, policymakers and health experts have promoted the use of performance-based bonuses to motivate health-care workers to follow best practices and ensure that patients receive key medical services. As part of this, the international research community is working to measure when and how such pay-for-performance programs are most effective. To help build a body of evidence on how to encourage and support quality healthcare, the World Bank supported a study of government-run and faith-based health clinics in Rwanda. The 23-month evaluation, the first rigorous one of its kind in a low-income country, found that performance-based bonuses helped raise the quality and use of health services for women and children. This Evidence to Policy note was jointly produced by the World Bank Group, the Strategic Impact Evaluation Fund (SIEF), and the British governments Department for International Development.Publication Using Performance Incentives to Improve Health Outcomes(World Bank, Washington, DC, 2012-06)This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0-11 months and on the height-for-age of children 24-49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill.Publication Paying Primary Health Care Centers for Performance in Rwanda(World Bank, Washington, DC, 2010-01)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.Publication Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector(World Bank, 2010-03-31)The purpose of this study is to examine the feasibility of introducing Results-Based Financing (RBF) in Tajikistan's health sector. Several countries have experience with RBF in low-income settings, and lessons learned can be interesting for Tajikistan. Technically, RBF is a retrospective provider payment that can be designed to reimburse providers for contractually defined services and specific compliance targets, including for efficiency and quality targets. In Tajikistan RBF will be linked to ongoing provider payment reforms. Therefore, the chapter also provides a brief overview on provider payment mechanisms and experience with provider payment reforms and treatment patterns from middle- and higher-income countries. The objective of this feasibility study is to propose a sustainable RBF pilot program for two oblasts (Khatlon and Sughd), to cost-effectively improve maternal and child health (MCH) outcomes. The study aims to inform the health sector strategy and help the Government and partners to effectively design and use RBF mechanisms at three potential levels. First, the fiscal transfer from the central government to oblasts (regions) and rayons (districts) could be adjusted to include a bonus payment based on specific results achieved. Second, the provider payment method from oblast health fund pools to hospitals and outpatient facilities could reward providers based on results indicators. Third, a performance payment could be added to salaries paid to staff working in health facilities. It is expected that such a three-pronged approach could reinforce the financial incentive set through RBF to staff working in the administration and provision of care. If the staff responds to these incentives, then this could lead to better management in oblast and rayons, improved availability of financial resources and medical material in health facilities, and better treatment of patients. Combined, these behavioral changes will ultimately lead to better health results, including improved quality of care and in the longer-run improved health status.Publication Handshake, No. 3 (October 2011)(International Finance Corporation, Washington, DC, 2011-10)This issue includes the following headings: integrated health systems: Lesothos pioneering model; access to healthcare for the poor: lessons from Ghana, India, and Mexico; and cost efficiency: Singapores secret to healthcare.
Users also downloaded
Showing related downloaded files
Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.Publication Comoros Country Climate and Development Report(Washington, DC: World Bank, 2025-06-18)The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Mongolia Country Climate and Development Report(Washington, DC: World Bank, 2024-10-22)Mongolia’s development prospects are uniquely challenged by both the impacts of climate change and the global shift toward a low-carbon economy. The country’s efforts toward decarbonization pose significant challenges given the structurally high-emission intensity of its economy. While challenging, climate action also presents Mongolia with opportunities to achieve important development benefits. The effects of climate risks and the shift away from coal will have diverse impacts across different regions, communities, and socioeconomic levels. The report assesses the critical interconnections between Mongolia’s development ambitions and climate change action and identifies ways to transition to a more economically diversified, inclusive, and resilient development path. It highlights key climate and transition risks affecting Mongolia’s future development and presents a pathway to enhance climate mitigation and adaptation. The report also makes a case for strengthening policies to enhance resilience to climate change and ensure a just transition, particularly for the most vulnerable. The report is structured as follows: section 1 gives introduction. Section 2 delves into the linkages between development and climate in Mongolia and presents model-based findings on the economic and poverty impacts of climate change under different scenarios. Section 3 covers four in-depth sectoral analyses. The first two mainly focus on adaptation to climate change in the agriculture and water sectors. The third considers prospects for the extraction sector, while the fourth sectoral analysis focuses on decarbonizing power and heat generation. Section 4 shifts the focus to how the government can boost resilience for climate-vulnerable populations. Section 5 outlines options for mobilizing private and public financing and private investments to support the green transition. Section 6 examines the existing institutional and governance structure for climate action and presents recommendations to improve its effectiveness, and section 7 concludes with a framework for prioritizing the policy actions outlined in this report.Publication Guinea-Bissau Country Climate and Development Report(Washington, DC: World Bank, 2024-10-23)Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.