Performance-Based Financing for Maternal and Child Health: Non-Experimental Evidence from Cambodia and Burundi
Ellen Van de Poel presents the findings of two studies that evaluate the impact of Performance-Based Financing (PBF) in Burundi and Cambodia. Both studies exploit the geographic expansion of PBF to estimate its effect on the utilization of maternal and child health services using data from the Demographic Health Surveys.
The studies found PBF to raise institutional deliveries, but effects were larger among the non-poor. In Cambodia, a substantial part of this effect arose from switching the location of institutional births from private to public facilities. The impact of PBF on births in public facilities is much greater if accompanied by maternity vouchers that cover user fees. No effect on the volume of antenatal care was found in either study, although in Burundi the quality of antenatal care did improve substantially. The effects of PBF pilots were typically larger than those of the nationwide scale-up.
Cambodia has over a decade of experience with various PBF programs. Heterogeneous effects across schemes differing in design suggest that maintaining management authority within a health district while giving explicit service targets to facilities is more effective in raising utilization than contracting management to an NGO while denying it full autonomy and leaving financial penalties vague.
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