This study evaluates the impacts of another component of the program, demand-side incentives. Health centers received funding to endow women with gifts for meeting the following eligibility criteria: initiation of antenatal care within the first four months of a pregnancy, delivery in a health facility, and initiation of postnatal care within ten days of delivery.<sup>3</sup> Table 1 summarizes the eligibility criteria and the monetary values set as ceilings for each service. Gifts of a value of up to 5 USD were to be endowed for timely antenatal care and values of 6.67 and 3.33 USD were set for in-facility delivery and timely postnatal care respectively.<sup>4</sup> The facilities were provided with suggested content for the incentive packages. Women who received these in-kind transfers during a pregnancy were not eligible to receive them again for a duration of three years.

The program launched in October 2010 and facilities received last funding for the gifts in February 2013. When the program was launched, procurement of the gifts was done centrally by the Ministry of Health but procurement responsibility was shifted to the individual health centers. There were frequent reports of stock-outs of the gifts and many women who fulfilled eligibility criteria did not receive the gifts.

# Experimental Setup and Data

The demand-side in-kind transfers program was randomly introduced at the sector level.<sup>5</sup> For the impact evaluation of the CPBF, 19 districts were selected in four provinces (excluding the province of the capital city Kigali). These were the 18 districts participating in the impact evaluation of the PBF program in 2006-2008 and an additional district that was added to increase the statistical power of the study. The demand-side intervention was piloted in 30 sectors, and those were excluded from the study sample. Additional sectors were excluded if they did not contain a public or non-for-profit faith-based health center.<sup>6</sup> Sectors were blocked by district and poverty ranking, as defined by a social protection program (Vision Umurenge Program), and then randomized into 4 study arms.

In all study-arms, community health worker cooperatives were paid conditional on the completion of quarterly reports. In two of the study arms, cooperatives were also paid for the utilization of targeted services (pay-for indicators). Two study arms were selected for the implementation of the demand-side incentives, one with pay-for-indicators and one without. Forty-eight sectors were assigned to the payfor-reports intervention only and 50 sectors were assigned to each of the three other groups. This analysis focuses only on the impact of the demand-side transfer and compares the two study arms that implemented this program with the two that did not. Therefore, for the remainder of the paper, the

> 3 Health centers are the main first point of contact between the population and the health care system. These facilities provide both outpatient and inpatient care such as deliveries. At the tier above the health centers are the district hospitals followed by provincial hospitals and at the top tier are the country’s five referral hospitals. 4 To benchmark the gift values, it is estimated from household consumption data that in 2010 about 81 percent of the population lived on less than 3.10USD a day and 60 percent lived on less than 1.90USD a day ( <mark>iresearch.worldbank.org/PovcalNet).</mark>

> 5 Rwanda’s five provinces are divided into 30 districts, further divided into 416 sectors that are in turn divided into 2,150 cells encompassing the country’s 14,837 villages.

6 A sector typically contains a single public or non-for-profit faith-based health center with the catchment area of the health center corresponding to the boundary of the sector. However, there are some sectors that do not contain a health center and others have more than one.

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