Publication: Rwanda: Can Bonus Payments Improve the Quality of Health Care?
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.
“World Bank. 2013. Rwanda : Can Bonus Payments Improve the Quality of Health Care?. From evidence to policy;. © Washington, DC. http://openknowledge.worldbank.org/handle/10986/22606 License: CC BY 3.0 IGO.”
Other publications in this report series
PublicationCan Disadvantaged Kids Ever Catch Up with Better-off Peers?(Washington, DC, 2013-05)The World Bank is focused on developing and supporting programs that help children reach their potential and live lives free of poverty. To help build a body of evidence of what works, the World Bank financed an evaluation of a program in Jamaica that targeted mothers of babies stunted due to malnutrition. The mothers received either support or guidance on how to encourage their babies' development through play and language, or nutritional supplements, or a combination of the two. The children whose mothers had received the extra guidance were doing as well financially as the less disadvantaged (and non-stunted) children. This study is a rare look at the effects of early childhood intervention over the decades, giving policymakers and development experts tangible proof of the potential effects of early childhood development programs. A rare long-term study of the effects of an early childhood development program shows that children's lives can be improved by ensuring that they have the right stimulation and emotional support as babies and toddlers.
PublicationCan Scholarships Help Keep Kids in School?(World Bank, Washington DC, 2013-02)Cambodia has had numerous scholarship programs funded by the government and outside donors. A government program supported by the World Bank's Cambodia Education Sector Support Project was launched to test the optimal scholarship amount and measure the effect on both boys and girls. The program targeted 100 lower secondary (middle) schools that were not participating in other scholarship programs, focusing on those in poor areas and where non-enrollment was high. The scholarships had a substantial effect on student enrollment and attendance in 7th and 8th grades. More girls than boys received grants because they ranked higher for the risk of dropping out. The Cambodia study shows that scholarships can be an effective tool for encouraging students to stay in school after completing primary school-even in a low income setting. Boys and girls can benefit equally and that encouraging greater school attendance does not mean that the student's siblings will be expected by their families to make up the lost household or outside work time. Success depends on finding the optimal way to support children who might otherwise drop-out, both in terms of encouraging enrollment and ensuring that once in school, they can learn.
PublicationWhat's the Long-Term Impact of Conditional Cash Transfers on Education?(Washington, DC, 2013-06)Cash transfers are used around the world to better encourage poor families to take advantage of educational offerings by offering financial incentives that can boost their income. The Colombia study shows that these can be an important tool not only for encouraging families to enroll their children in school, but also keeping them there. Indeed, the results indicate that students whose families received the cash transfers were more likely to graduate high school, an educational milestone that opens doors to higher education and in developing countries especially, increases employment opportunities. The study showed that higher enrollment, and improved graduation rates, didn't necessarily translate into better learning. Students whose families received the cash transfers didn't show improvements in test scores when compared with students whose families didn't receive the money. It may be that teachers need better training to address the needs of low-income students, or more resources may be required for struggling students. Future research could consider linking cash transfers to school performance, to see whether this incentive encourages students (and their parents) to pay more attention to learning. As part of this, researchers would have to consider what support low-income households might need to monitor and assist their children in school. The Colombia study makes an important contribution to the body of evidence on the effectiveness of cash transfers in keeping kids in school and raising graduation rates. The next step is to understand how cash transfers, or other programs, can successfully be used to boost learning too.
PublicationDo Grants to Communities Lead to Better Health and Education?(Washington, DC, 2013-02)Indonesia, like many middle income countries, has difficulty providing universal access to education and adequate access to healthcare, particularly in poor and rural areas. To tackle these problems, the Government of Indonesia launched two large-scale programs in 2007. The programs both relied on cash transfers, but one targeted households and one targeted communities. In both cases, the transfers were designed to encourage families to meet basic health and education indicators, including prenatal visits for pregnant women, childhood immunization, regular weight monitoring, and school attendance. To push communities to focus on the most effective policies, a portion of subsequent year grants is based on how well communities do in meeting the previous year's health and education targets. In this way, the program takes aspects of conditional cash transfer and pay-for-performance programs and reformulates them to encourage community-wide performance and accountability. In order to test the effectiveness of linking grants to the previous year's performance, a second version of the program was carried out in which communities received the money irrespective of the previous year's performance. The grants have ranged from an average of $8,500 in 2007 to $18,200 in 2009. This World Bank supported program now reaches about 5.4 million people.
PublicationCan Entrepreneurship Training Improve Work Opportunities for College Graduates?(Washington, DC, 2013-04)Improving educational achievement for youth doesn't always result in better employment opportunities, and this can be especially acute in developing countries. As the World Bank's 2013 world development report highlights, the mismatch between the skills and aspirations of college graduates and the realities of labor markets not only limits a country's economic development, but also affects social cohesion. Joblessness and underemployment are viewed as some of the triggers of the Arab Spring, which started with Tunisia's jasmine revolution in early 2011. In Tunisia, the World Bank worked with the government to evaluate a program designed to give university students entrepreneurship training and assistance developing a business plan. The evaluation found that the program increased self-employment and helped students develop some skills associated with successful entrepreneurship. The lessons learned from the evaluation will help policymakers and development experts hone programs that deliver an impact.