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

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

doi:10.1016/j.jhealeco.2014.12.001

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

J Health Econ. 2015 Mar:40:1-9. doi: 10.1016/j.jhealeco.2014.12.001. Epub 2014 Dec 12.

Authors

Damien de Walque¹, Paul J Gertler², Sergio Bautista-Arredondo³, Ada Kwan³, Christel Vermeersch⁴, Jean de Dieu Bizimana⁵, Agnès Binagwaho⁶, Jeanine Condo⁷

Affiliations

¹ Development Research Group, The World Bank, United States. Electronic address: ddewalque@worldbank.org.
² Haas School of Business, University of California, Berkeley, United States.
³ National Institute of Public Health, Cuernavaca, Mexico.
⁴ The World Bank, United States.
⁵ Camris International, United States.
⁶ Ministry of Health, Government of Rwanda, Kigali, Rwanda; Senior Lecturer, Harvard Medical School, Department of Global Health and Social Medicine; Clinical Professor of Pediatrics, Geisel School of Medicine at Dartmouth College, United States.
⁷ School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.

PMID: 25554976
DOI: 10.1016/j.jhealeco.2014.12.001

Abstract

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient.

Keywords: Africa; Couple testing; HIV testing and counseling; Health human resources; Performance-based financing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

AIDS Serodiagnosis / economics*
AIDS Serodiagnosis / statistics & numerical data
Counseling / economics*
Counseling / statistics & numerical data
Female
HIV Infections / diagnosis
Humans
Male
Prospective Studies
Reimbursement, Incentive* / organization & administration
Rwanda