2026-07-01http://hdl.handle.net/123456789/416327Paying 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.application/pdftext/plainCC BY 3.0 IGOhttp://creativecommons.org/licenses/by/3.0/igo/ALCOHOLALCOHOL USEANEMIAANTENATAL CAREBLEEDINGBODY WEIGHTCHILD GROWTH MONITORINGCHILD HEALTHCHILD HEALTH CARECHILD HEALTH SERVICESCHILD SURVIVALCHILDBIRTHCLEANLINESSCLINICAL PRACTICECLINICSCOMMUNITY HEALTHCOMMUNITY HEALTH WORKERSCONTRACEPTIVE USECONTRACEPTIVE USERSDEVELOPING COUNTRIESDIABETESDISTRICT HOSPITALDRUGSEMPOWERING WOMENEXPENDITURESFAMILIESFAMILY MEMBERSFAMILY PLANNINGFINANCIAL MANAGEMENTGENOCIDEGLOBAL DEVELOPMENTGLOBAL HEALTHGOITERGONORRHEAGRIDHEALTH BEHAVIORHEALTH CARE CENTERSHEALTH CARE SERVICESHEALTH CENTERSHEALTH CENTRESHEALTH FACILITIESHEALTH FACILITYHEALTH FINANCINGHEALTH INSURANCEHEALTH INTERVENTIONSHEALTH OUTCOMESHEALTH POLICYHEALTH PROBLEMSHEALTH SERVICESHEALTH SYSTEMHEALTH WORKERSHEART DISEASEHIGH BLOOD PRESSUREHIVHOSPITALHOSPITALSHUMAN DEVELOPMENTIMMUNIZATIONINCOMEINFANTINFANT MORTALITYINFANTSINFORMED CONSENTINTERVENTIONLAB TESTSLABORATORY SERVICESLAND OWNERSHIPLOW BIRTH WEIGHTLOW-INCOME COUNTRIESMALARIAMALARIA PROPHYLAXISMALNOURISHED CHILDRENMARITAL STATUSMATERNAL AND CHILD HEALTHMATERNAL CAREMATERNAL HEALTHMATERNAL HEALTH SERVICESMATERNAL MORTALITYMEDICAL CAREMEDICAL DOCTORSMEDICAL PERSONNELMEDICAL SUPPLIESMINISTRY OF HEALTHMISCARRIAGESMORBIDITYMORTALITYMOSQUITO NETSMOTHERNATIONAL HEALTHNAUSEANEWBORNNUMBER OF CHILDRENNURSESNUTRITIONOBSTETRIC CAREOFFICIAL DEVELOPMENT ASSISTANCEPAP SMEARPATIENTPATIENTSPHARMACYPHYSICAL EXAMINATIONSPHYSICIANPHYSICIANSPOLICY IMPLICATIONSPOLICY RESEARCHPOLICY RESEARCH WORKING PAPERPOPULATION DENSITYPOSTNATAL CAREPREGNANCIESPREGNANCYPREGNANT WOMENPRENATAL CAREPRENATAL CARE UTILIZATIONPREVENTIVE HEALTHPREVENTIVE HEALTH CAREPRIMARY CAREPRIMARY EDUCATIONPRIMARY HEALTH CAREPRIMARY HEALTH CARE FACILITIESPROBABILITYPROGRESSPROPHYLAXISPUBLIC HEALTHQUALITY CAREQUALITY OF CAREQUALITY OF HEALTHQUALITY OF SERVICESRATES OF GROWTHREDUCING MATERNAL MORTALITYRISK PREGNANCIESRURAL AREASSAFE MOTHERHOODSERVICE DELIVERYSERVICE PROVISIONSEXSKILLED ATTENDANCESKILLED ATTENDANCE AT DELIVERYSKILLED ATTENDANTSSOCIAL RESEARCHSOCIOECONOMIC STATUSSTDSTISSYMPTOMSSYPHILISTETANUSTOBACCOTREATMENTTROPICAL MEDICINETUBERCULOSISVACCINATIONVACCINATION CAMPAIGNVACCINEVACCINESVITAL SIGNSVOMITINGWOMANWORKERSYOUNG CHILDREN