Measuring Changes in Infant Birthweight due to Performance-based and Unconditional Financial Incentives

Study Context

Every year, an estimated 16% of all infants globally and an estimated 10% in Zambia are born with low birth weight (birth weight < 2500 grams). Improvements in the quality of healthcare, particularly the early initiation of high quality prenatal and antenatal care in pregnancy, have been found to reduce the likelihood of low infant birth weight.

Study Design

This study leveraged the roll out of the Zambia Results Based Financing (ZRBF) pilot project (2012-2015), which offered financial incentives to healthcare providers to improve their productivity and the quality of maternal and child healthcare. The study used a triple differences design to investigate the relative effects on changes in infant birth weights of paying healthcare providers using performance-based, unconditional, or no financial incentives at all, to provide prenatal and antenatal care.

Results and Policy Lessons

Results reveal that performance-based and unconditional financial incentives have remarkably similar effects on birth outcomes. Benefits are, however, concentrated in babies of women at higher risk of bearing low birthweight children. Triple difference and regression discontinuity results are qualitatively similar.

While districts receiving performance-based financial incentives had a larger number of earlier initiated antenatal care (ANC) visits, the treatment did not always translate into commensurate improvements in the quality of ANC visits.

The findings imply that unconditional financial transfers, which are also more cost-effective, can be an effective tool in improving child health outcomes.