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

47 Pages Posted: 6 Aug 2019

See all articles by Tashrik Ahmed

Tashrik Ahmed

World Bank

Aneesa Arur

World Bank

Damien de Walque

World Bank; World Bank - Development Research Group (DECRG)

Gil Shapira

The World Bank

Date Written: July 30, 2019

Abstract

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.

Keywords: Health Care Services Industry, Health Service Management and Delivery, Gender and Development

Suggested Citation

Ahmed, Tashrik and Arur, Aneesa and de Walque, Damien and Shapira, Gil, Incentivizing Quantity and Quality of Care: Evidence from an Impact Evaluation of Performance-Based Financing in the Health Sector in Tajikistan (July 30, 2019). World Bank Policy Research Working Paper No. 8951. Available at SSRN: https://ssrn.com/abstract=3430566

Tashrik Ahmed (Contact Author)

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Aneesa Arur

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

Damien De Walque

World Bank ( email )

1818 H Street, N.W.
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/ddewalque

World Bank - Development Research Group (DECRG)

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

Gil Shapira

The World Bank ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

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