impact, having some treatment clusters classified as control clusters (or with treatment probability smaller than one) will increase coverage rates in the control group. Similarly, coverage rates in the treatment group will be lowered by having control clusters classified as treatment ones. As a result, the estimated difference between the groups will be smaller than the actual difference. Second, detailed information was only provided on the last pregnancy of each respondent. Therefore, the data are not representative by year of birth.

Figure 3 presents the annual impact coefficients of the in-kind transfers on timely antenatal care. We restrict the sample to births after June 2011 to assure women were exposed to the intervention for the entire duration of their pregnancy. The left frame shows the results of the regression using the binary treatment indicator and the right frame the results when using treatment probabilities. The annual treatment coefficients are plotted with the 95 percent confidence intervals. In both specifications, the treatment coefficients reduce with the duration of implementation and the 2011 treatment coefficient is statistically significant. The treatment coefficients for 2012 are significant at the 10 percent level in the specification using the binary treatment indicator and at the 5 percent level in the other specification. For all other years, we cannot reject the coefficients equaling zero and they are estimated to be negative for 2014 and 2015. These results suggest that the estimated impact found in our primary analysis might have been larger if the follow-up survey was fielded earlier when health centers were more likely to have stocks of gifts to reward eligible women.

As in the analysis using the CPBF impact evaluation data, we do not find any impact on in-facility deliveries and we do not present the results for brevity. As for postnatal care, we are unable to construct a measure comparable to the one we are using in our primary analysis with the RDHS data. The goal of the program was to bring women back to the health centers after they were discharged following their deliveries. For women who received postpartum care immediately after delivery, the RDHS now collects data on the timing of additional postnatal consultations. More than 50 percent of the women recorded to receive postnatal care are reported to receive it within one hour after delivery. Using the timing of care according to the RDHS will imply rate of 45 percent of postnatal within ten days after delivery in comparison to 17 percent in the impact evaluation data. For comparison, rates of timely antenatal care are 77 percent in both data sets.

# Discussion

We find that conditional demand-side in-kind transfers can be effective in increasing uptake of health services. The scheme that was introduced as part of the Rwanda Community Performance-Based Financing program caused a fairly substantial increase in the rate of women who received timely antenatal and postnatal care. We are able to assign a causal impact of the demand-side transfers even though there were other interventions or factors that increased maternal health service utilization as portrayed by the increase in health service utilization by the control group.

The demand-side incentives improved indicators that were not impacted by incentivizing health providers through the Performance-Based Financing scheme at the health center. However, we cannot compare the effectiveness of incentivizing health providers versus only incentivizing users of the health care system as the demand-side transfers were introduced on top of the countrywide facility-level PBF 10