Paying for Performance in Health Care: Empirical Evidence from Rwanda's National Program

Featuring

Sebastian Bauhoff
Economist
RAND Corporation

Moderated by

Amanda Glassman
Director of Global Health Policy and Senior Fellow
Center for Global Development

Pay-for-performance (PFP) has emerged as a popular prescription to improve the performance of health systems in low and middle-income countries. However, there is limited economic and empirical evidence to support the effective design and implementation of such programs.

We analyze impacts of Rwanda’s national PFP program using two waves of data from the Rwanda Demographic and Health Surveys collected before and after the randomized roll-out. We focus on two concerns with PFP in health care, joint production (a common input or process affecting multiple outputs) and multitasking (the reallocation of effort toward rewarded tasks). The findings suggest that Rwanda’s program improved some rewarded and unrewarded services, but had no detectable impact on health outcomes. We find no evidence of multitasking, and find mixed effects of the program by baseline levels of facility quality, with most improvements in the medium quality tier.