Using provider performance incentives to increase HIV testing and counseling services in Rwanda

Walque, Damien de; Gertler, Paul; Bautista‐Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel M. J.; Bizimana, Jean de Dieu; Binagwaho, Agnès; Condo, Jeanine

doi:10.1016/j.jhealeco.2014.12.001

Cited by 61 publications

(48 citation statements)

References 19 publications

(14 reference statements)

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“…Supply-side factors might be remediated by additional staff or training, supply chain strengthening, service integration, stronger engagement of village health workers,[20] or performance-based financing. [21] Demand side factors might be addressed with, for example, transportation vouchers, incentives (e.g., for institutional delivery)[22], mother-to-mother groups, or community engagement. [23] Likewise, active case finding coupled SMS notification could minimize delays after early infant diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

McCoy

Fahey

Buzdugan

et al. 2016

Aids

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Background We assessed Zimbabwe’s progress towards elimination of mother-to-child HIV transmission (eMTCT) under Option A. Methods We analyzed 2012 and 2014 cross-sectional serosurvey data from mother-infant pairs residing in the same 157 health facility catchment areas (CA) randomly sampled from 5 provinces. Eligible women were ≥16 years and mothers/caregivers of infants born 9–18 months prior. We aggregated individual-level questionnaire and HIV serostatus within CA or district to estimate MTCT and the number of HIV-infected infants; these data were mapped using facility GPS coordinates. Findings A weighted population of 8,800 and 10,404 mother-infant pairs was included from 2012 and 2014, respectively. In 2014, MTCT among HIV-exposed infants was 6.7% (95% confidence interval (CI): 5.2,8.6), not significantly different from 2012 (8.8%, 95%CI: 6.9,11.1, p=0.13). From 2012–2014, self-reported antiretroviral therapy or prophylaxis among HIV-infected women increased from 59% to 65% (p=0.05), as did self-reported infant antiretroviral prophylaxis (63% vs. 67%, p=0.08). In 2014, 65 (41%), 55 (35%), and 37 (24%) CAs had the same, lower, and higher MTCT rate as in 2012, respectively. MTCT in 2014 varied by CA (median=0%, mean=4.9%, interquartile range (IQR)=0–10%) as did the estimated number of HIV-infected infants (median=0, mean=1.1, IQR=0–1.0). Also in 2014, 106 (68%) CAs had MTCT=0%. Geovisualization revealed clustering of CAs where both MTCT and the estimated number of HIV-infected infants were relatively high. Interpretation Although MTCT is declining in Zimbabwe, geospatial analysis indicates facility-level variability. CAs with high MTCT rates and a high burden of HIV-infected infants should be the highest priority for service intensification.

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Section: Discussionmentioning

confidence: 99%

Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

McCoy

Fahey

Buzdugan

et al. 2016

Aids

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“…Well-targeted incentives may improve efficiency, but can also crowd out intrinsic motivation leading to worse results than unconditional payments that elicit voluntary efforts. Previous studies on incentives to improve health in developing countries have focused primarily on payments to individuals for their own health as in Powell-Jackson et al (2015) or to caregivers to provide specific services as in De Walque et al (2015). Here we provide incentives to health workers based on client outcomes, targeting weight-for-age malnutrition among children attending urban day care centers in Chandigarh, India.…”

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confidence: 99%

Impact of Caregiver Incentives on Child Health: Evidence from an Experiment with Anganwadi Workers in India

Singh

Masters

2016

SSRN Journal

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a b s t r a c tThis paper tests the effectiveness of performance pay and bonuses among government childcare workers in India. In a controlled study of 160 ICDS centers serving over 4000 children, we randomly assign workers to either fixed bonuses or payments based on the nutritional status of children in their care, and also collect data from a control group receiving only standard salaries. In all three study arms mothers receive nutrition information. We find that performance pay reduces underweight prevalence by about 5 percentage points over 3 months, and height improves by about one centimeter. Impacts on weight continue when incentives are renewed and return to parallel trends thereafter. Fixed bonuses are less expensive but lead to smaller and less precisely estimated effects than performance pay, especially for children near malnutrition thresholds. Both treatments improve worker effort and communication with mothers, who in turn feed a more calorific diet to children at home.

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“…1). One study was a cluster randomised trial [33] while the other three articles were observational studies [34–36]. Two studies were from Cote d’Ivoire, one study was from Rwanda, and one study was from Kenya (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The average duration of studies was 1.6 years (Table 1). The cluster randomised trial did not report sequence generation and allocation concealment [33] (Additional file 3: Table S1). Two of the observational studies did not control for confounding [34, 36] and one did not report losses to follow-up [27] (Additional file 4: Table S2).…”

Section: Resultsmentioning

confidence: 99%

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

Suthar

Nsanzimana

Bärnighausen

et al. 2017

BMC Health Serv Res

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BackgroundAlthough domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines.MethodsPubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207.ResultsFour studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported.ConclusionsAlthough the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1962-9) contains supplementary material, which is available to authorized users.

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Using provider performance incentives to increase HIV testing and counseling services in Rwanda

Cited by 61 publications

References 19 publications

Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

Impact of Caregiver Incentives on Child Health: Evidence from an Experiment with Anganwadi Workers in India

Performance-based financing for improving HIV/AIDS service delivery: a systematic review

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