Financial Incentives to Increase Utilization of Reproductive, Maternal, and Child Health Services in Low- and Middle-Income Countries : A Systematic Review and Meta-Analysis
Financial incentives for health providers and households are increasingly used to improve reproductive, maternal, and child health service coverage in low- and middle-income countries. This study provides a quantitative synthesis of their effective...
| Main Authors: | , , , |
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| Format: | Working Paper |
| Language: | English |
| Published: |
World Bank, Washington, DC
2021
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/undefined/426541633376367601/Financial-Incentives-to-Increase-Utilization-of-Reproductive-Maternal-and-Child-Health-Services-in-Low-and-Middle-Income-Countries-A-Systematic-Review-and-Meta-Analysis http://hdl.handle.net/10986/36344 |
| Summary: | Financial incentives for health
providers and households are increasingly used to improve
reproductive, maternal, and child health service coverage in
low- and middle-income countries. This study provides a
quantitative synthesis of their effectiveness. A systematic
review was conducted of the effects of performance-based
financing, voucher, and conditional cash transfer programs
on six reproductive, maternal, and child health service
indicators, with eligible evidence coming from randomized
controlled trials and studies using double-difference,
instrumental variables, and regression discontinuity
designs. Four literature searches were conducted between
September 2016 and March 2021 using seven academic
databases, Google Scholar, development agency and think tank
websites, and previous systematic reviews. Random effects
meta-analysis was used to obtain mean effect sizes. From 58
eligible references 212 impact estimates were extracted,
which were synthesized into 130 program-specific effect
sizes. Financial incentives increase coverage of all
considered reproductive, maternal, and child health
indicators, but mean effects sizes are of modest magnitude.
Effect size heterogeneity is typically low to moderate, and
there is no indication that study bias risk, baseline
indicator levels, or a combination of provider- and
household-level incentives impact effect sizes. There is,
however, weak evidence that mean effect sizes are somewhat
smaller for performance-based financing than for voucher and
conditional cash transfer programs, and that the increase in
income, rather than the incentive itself, drives coverage
improvements. Financial incentives improve reproductive,
maternal, and child health service coverage. If future
research confirms the preliminary finding that
performance-based financing has smaller effects, voucher and
conditional cash transfer programs are the preferred policy
option among incentive interventions to achieve higher
reproductive, maternal, and child health service coverage.
The relative effectiveness and efficiency of incentives
compared with unconditional increases of provider and
household incomes, however, need to be studied further. |
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