The effects of performance incentives on the utilization and quality of maternal and XXXX care in Burundi.

@entity1 @entity1297
Africa's progress towards the health related Millennium Development Goals remains limited. This can be partly explained by inadequate performance of health care providers. It is therefore critical to incentivize this performance. Payment methods that reward performance related to quantity and quality, called @entity1297 ( @entity1297 ), have recently been introduced in over 30 African countries. While @entity1297 meets considerable enthusiasm from governments and donors, the evidence on its effects is still limited. In this study we aim to estimate the effects of @entity1297 on the utilization and quality of maternal and @entity1 care in Burundi. We use the 2010 Burundi Demographic and Health Survey (August 2010-January 2011, n  =  4916 @entity1 ) and exploit the staggered rollout of @entity1297 between 2006 and 2010, to implement a difference-in-differences approach. The quality of care provided during antenatal care (ANC) visits improved significantly, especially among the better off, although timeliness and number of ANC visits did not change. The probability of an institutional delivery increased significantly with 4 percentage points among the better off but no effects were found among the poor. @entity1297 does significantly increase this probability (with 5 percentage points) for @entity1 where @entity1297 was in place from the start of their pregnancy, suggesting that @entity1 are encouraged during ANC visits to deliver in the facility. @entity1297 also led to a significant increase of 4 percentage points in the probability of a @entity1 being fully vaccinated, with effects more pronounced among the poor. @entity1297 improved the utilization and quality of most maternal and @entity1 care, mainly among the better off, but did not improve targeting of unmet needs for ANC. Especially types of care which require a behavioral change of health care workers when the @entity1 is already in the clinic show improvements. Improvements are smaller for services which require effort from the provider to change @entity1 ' utilization choices.
