81516 enGender Impact: The World Bank’s Gender Impact Evaluation Database Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda Damien de Walque, Paul Gertler, Sergio Bautista-Arredondo, Ada Kwan, Christel Author(s) Vermeersch, Jean de Dieu Bizimana, Agnes Binagwaho, Jeanine Condo Contact ddewalque@worldbank.org Country Rwanda Organizing Theme Health Status Completed Intervention Category Pay for Performance Sector Health, Nutrition & Population Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme’s impact on individual and couples HIV testing and counseling and using data from a prospective Abstract quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive. Gender Connection Gender Focused Intervention Gender Outcomes Sexual and Reproductive Health Outcomes IE Design Difference in Difference In this P4P scheme, payments are made directly to primary health facilities and used at each facility's discretion. Each facility was rated with and index comprised of 14 key maternal Intervention and child health-care output indicators. The size of the payment depends upon the facility's score on the index. The payment of control facilities was increased so that the average payment received by controls equals the average P4P payment in treatment facilities. Facilities started receiving HIV/AIDS P4P in January 2007. Exposure lasted between 12-15 Intervention Period months. Only health facilities offering HIV/AIDS services were included in the HIV/AIDS P4P model. There were 24 such facilities, and 10 were included in the treatment and 14 included in the comparison group. Additionally, a household survey was administered to a sample of Sample population 1000 households with an HIV+ member and 600 randomly sampled neighbors. At baseline the sample is comprised of 438 individuals in the treatment group and 445 in the comparison group. Health facilities that received P4P were compared to health facilities that did not receive Comparison conditions the program. The control facilities received an increase in funds so that the average funds of treatment was same as the funds for control facilities. Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Unit of analysis Health facilities Evaluation Period August 2006-July 2008. The P4P program leads to a significant 14.5% increase in the probability that an individual is tested. However, these results are completely driven by individuals living in a couple. The Results impact on couple is tested is particularly strong amongst discordant couples, encouraging the partner to test for HIV status. The original randomized design was slightly compromised; as a result, the study is Primary study limitations considered quasi-experimental. The World Bank-Netherlands Partnership Program, Spanish Impact Evaluation Fund, the Funding Source British Economic and Social Research Council, Government of Rwanda de Walque, D., Gertler, P. J., Bautista-Arredondo, S., Kwan, A., Vermeersch, C., de Dieu Bizimana, J., ... & Condo, J. (2013). Using Provider Performance Incentives to Increase Reference(s) HIV Testing and Counseling Services in Rwanda. World Bank Policy Research Working Paper No. 6364 Link to Studies https://openknowledge.worldbank.org/handle/10986/13134 Microdata Last updated: 14 August 2013 2