Rwanda: Can Bonus Payments Improve the Quality of Health Care?

Ensuring that women and children receive quality health care is a key to alleviating poverty, but in many developing countries, access to appropriate medi­cal care is limited. In recent years, policymakers and health experts have promoted the use of performance-based bonuses to motivate health-care workers to fol­low best practices and ensure that patients receive key medical services. How such pay-for-performance programs are most effective? Can bonus payments have a positive impact on the type and quality of care provided by health centers and how, in turn, can affect health outcomes?

The Rwanda study tested the use of bonuses for indicators related to healthcare for women and children, often the most vulnerable populations in poor countries. The study showed that pay-for-performance can work, and that it worked best when payments rates are substantial and when the recipient of the payments (in this case the health center) has greater control over the service being provided.

The study makes an important contribution to understanding how pay-for-performance can help women and children obtain the care they need to reduce the risk of death and protect and improve their health.