17 research outputs found

    Performance-Based Financing, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo

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    Performance-based financing becomes a common strategy to improve health sector quality. The findings of this paper imply that performance-based financing should take motivational effects and levels of provider capacity into account. Using a field experiment in the Democratic Republic of Congo, we find that financial incentives led to more effort from health workers on rewarded activities, without deterring effort on non-rewarded activities. We also find a shift from intrinsic to extrinsic motivation. Finally, the increased effort by health workers proved unsuccessful and led to a reduction in revenue, suggesting that health workers lacked the capacity to develop appropriate strategies to perform

    Financial Incentives are Counterproductive in Non-Profit Sectors: Evidence from a Health Experiment

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    Financial incentives for service providers are becoming a common strategy to improve service delivery. However, this strategy will only work if demand for the service responds as expected. Using a eld experiment in the Democratic Republic of Congo, we show that introducing a performance-based financing mechanism in the health sector has counterproductive effects because demand is non-standard: despite reduced prices and eased access, demand for health decreased, child health deteriorated, workers' revenue dropped. Ironically, expected perverse effects of incentives on worker behavior were not realized: incentives led to more effort from health workers on rewarded activities without deterring effort on non-rewarded activities, nor inducing significant score manipulation or free-riding. We also find a decline in worker motivation following the removal of the incentives, below what it would have been in the absence of exposure to the incentives. Management tools used in for-pro t sectors are thus inappropriate in non-pro t sectors such as health where user and worker rationalities are specific

    Girl Empower Intervention Baseline Survey

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    This report presents the results from the baseline assessment of the International Rescue Committee’s (IRC) Girl Empower (GE) program in Nimba County, Liberia. GE is a program in rural communities that seeks to help 13–to–14-year-old girls make healthy life choices and decrease their risk of sexual abuse. The program centers on weekly meetings between girls and trained local mentors, during which the girls learn about life skills and financial literacy. GE also holds monthly discussion groups for participants’ caregivers, and trains local health and psychosocial care providers on how to improve and expand services for survivors of gender-based violence. Girls are also equipped with savings accounts, and small deposits are made on their behalf. The GE baseline assessment is part of a randomized evaluation, which will assess the program’s impact. Primary investigators from the Population Council, the World Bank, and the IRC lead the evaluation’s research team, and Innovations for Poverty Action is responsible for the survey data collection

    Trois essais sur les politiques de santé dans les pays en développement

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    Trois essais sur les politiques de santé dans les pays en développement.No English summary available

    Pay-for-Performance, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo *

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    Abstract The paper studies the eects of a nancing mechanism for the health sector in which governmental payment to health facilities is contingent upon the number of patients for some predetermined health services, as opposed to a xed payment. Even though performance-based nancing models have been implemented in developed and developing countries in various settings and forms, the scientic evidence on its impact on health worker eort and consequent health outcomes remains thin. Using a eld experiment in the Democratic Republic of Congo, we give evidence that nancial incentives led to more eort from health workers with respect to rewarded services. Equally important, health workers did not substitute eort put in non-rewarded activities. However, the increase in overall sta motivation happened at the expense of its intrinsic component. Finally, the increased eort put in by the health workers proved unsuccessful at attracting more patients, suggesting that health workers lacked means or inventiveness to meet their objective

    Financial Incentives are Counterproductive in Non-Profit Sectors: Evidence from a Health Experiment *

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    Abstract Financial incentives for service providers are becoming a common strategy to improve service delivery. However, this strategy will only work if demand for the service responds as expected. Using a field experiment in the Democratic Republic of Congo, we show that introducing a performance-based financing mechanism in the health sector has counterproductive effects because demand is non-standard: despite reduced prices and eased access, demand for health decreased, child health deteriorated, workers' revenue dropped. Ironically, expected perverse effects of incentives on worker behavior were not realized: incentives led to more effort from health workers on rewarded activities without deterring effort on non-rewarded activities, nor inducing significant score manipulation or free-riding. We also find a decline in worker motivation following the removal of the incentives, below what it would have been in the absence of exposure to the incentives. Management tools used in for-profit sectors are thus inappropriate in non-profit sectors such as health where user and worker rationalities are specific

    L’assignation alĂ©atoire comme mĂ©thode d’évaluation des politiques publiques

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    International audienceAlors que, dans une Ă©conomie concurrentielle, le marchĂ© est censĂ© assurer la sĂ©lection des stratĂ©gies industrielles ou commerciales les plus efficaces, les politiques publiques sont mises en Ɠuvre dans un contexte qui n’est gĂ©nĂ©ralement pas propice Ă  la dĂ©termination de leur efficacitĂ©. Fonder les politiques publiques sur des preuves scientifiques rigoureuses ouvre pourtant la voie Ă  la justification de l’action publique en facilitant la gĂ©nĂ©ralisation de programmes qui ont tĂ©moignĂ© de leur efficacitĂ© et, Ă  l’inverse, en permettant de motiver des modifications apportĂ©es Ă  ceux dont les rĂ©sultats sont moins convaincants

    Dépenses de santé et équité dans l'accès aux services de santé dans les pays en développement

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    ED EPSInternational audienceOver the last ten years, health has received a higher priority in development policies, as shown by a sharp increase in health expenditure. This increase will contribute effectively to poverty reduction only if such expenditure is efficient and if access to health services becomes more equitable. This paper contributes to the study of health equity in developing countries, with particular attention paid to child and maternal health services. We find that the poor benefit somewhat more than the rich from increased public health expenditures, but that the subsequent improvement in health equity is only marginal. In addition we find that access to health services depends considerably on the socioeconomic characteristics of households, most notably on the mother's education level. A policy targeting schooling of girls would then significantly improve access to health services for the poor. Finally, we find that improvements in several dimensions of governance would also make access to health services appreciably more equitable.Au cours des années 2000, la question de la santé a gagné en priorité dans les politiques de développement, ce qui s'est traduit par une forte augmentation des dépenses dans le secteur de la santé. Pour que ces politiques contribuent efficacement à la réduction de la pauvreté il faut non seulement que les dépenses de santé soient efficaces mais aussi que l'équité dans l'accÚs aux services de santé s'améliore. Cet article vise à apporter une contribution à cette problématique de l'équité en santé dans les pays en développement en considérant le cas de l'accÚs aux services de santé infantile et maternelle. Nous montrons dans ce cadre que des dépenses publiques de santé plus importantes profitent un peu plus aux pauvres qu'aux riches mais qu'une progression de ces dépenses se traduit au mieux par une amélioration marginale de l'équité de l'accÚs aux services de santé. Nous montrons également que l'accÚs aux services de santé est fortement influencé par les caractéristiques socioéconomiques des ménages, et notamment par l'éducation des mÚres de famille. Une politique de généralisation de l'éducation des filles pourrait ainsi contribuer à améliorer significativement l'accÚs à la santé pour les pauvres. Nous trouvons enfin que des améliorations de la gouvernance dans plusieurs de ses dimensions pourraient également contribuer de maniÚre trÚs sensible à une distribution de l'accÚs aux services de santé plus équitable

    Equity in Access to Health Services in Developing Countries

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    In the decade 2000-2010, development policy has given health care higher priority, which has translated as a sharp global increase in health expenditure. This increase can only effectively help reduce poverty if the expenditure is efficient and if access to health services becomes more equitable. This paper contributes to the study of health equity in developing countries, focusing specifically on child and mother health care services. Our research highlights that increased public health expenditure is directed more towards the poor than the rich, but that health equity is only marginally improved. We also find that access to health services is significantly dependent on household socioeconomics, including the mother?s level of education. A policy targeting better schooling for girls would therefore significantly improve access to health services among poor populations. Finally, we identify several dimensions of governance that could help significantly close the health equity gap. JEL Classification: I1, I3.health, equity, developing country

    Risk Information, Risk Salience, and Adolescent Sexual Behavior: Experimental Evidence from Cameroon

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    Results from a randomized experiment conducted with teenage schoolgirls in Cameroon suggest that HIV prevention interventions can be effective at reducing the incidence of teen pregnancy in the following 9-12 months by over 25 percent. We find little difference in effectiveness between one-time, one-hour sessions delivered directly to students by specialized consultants and sessions delivered through regularschool staff trained over two days by specialized consultants. We also find little difference between the standard “Abstain, Be Faithful, Use Condoms” curriculum and an enriched curriculum that includes informationon the heightened risk of cross-generational sex. Lastly, a one-time, one-hour self-administered questionnaire on HIV and sexual behavior has an equally large impact on teen pregnancy. These results suggest that rural teenage schoolgirls’ sexual behavior is highly responsive to even small interventions that make the risks of HIV and pregnancy salient. We find no effects among urban schoolgirls, who are more exposed to information and experience much lower rates of teenage pregnancy under the statusquo
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