By Adam Wagstaff, Damien de Walque, Jed Friedman, and Sven Neelsen
A blogpost on financial incentives in health by one of us in September 2015 generated considerable interest. The post raised several issues, one being whether demand-side financial incentives (like maternal vouchers) are more or less effective at increasing the uptake of key maternal and child health (MCH) interventions than supply-side financial incentives (variously called pay-for-performance (P4P) or performance-based financing (PBF)).
The four of us are now hard at work investigating this question — and related ones — in a much more systematic fashion. And we'd very much welcome your help.
A motivating chart from a quick-and-dirty analysis
The September 2015 blogpost highlighted just 3 recent evaluations – two PBF and one demand-side intervention. After the post, one of us did a quick literature trawl to unearth other studies that estimated impacts of demand- and supply-side side financial incentives on MCH outcomes in a credible way. The results were presented at a symposium on Innovations in Global Health Financing held at Erasmus University Rotterdam in November 2015. The evidence base included 5 PBF schemes and 7 demand-side schemes, including 3 voucher schemes and 4 CCT schemes. On average, the PBF schemes have much smaller impacts on the uptake of MCH interventions than the demand-side schemes – see the chart below.
Getting more systematic
The chart is food for thought, but raises lots of questions. Do the results hold for all studies on the topic? Are there systematic differences within each class of program? For example, do CCT schemes, on average, have larger impacts than voucher schemes? Do PBF schemes with some features have larger impacts than those without them? And are they so much more effective that on average they have larger impacts than demand-side interventions? What about cost-effectiveness?