Advancing Health Care Financing in Rwanda Using Performance Data
A web-based system for collecting and analyzing performance data in Rwanda is not only helping to increase the efficiency, accuracy, and transparency of the health care financing system, but has also resulted in reporting of data by 100 percent of facilities—a notable monitoring and evaluation success.
Performance-based financing, as put in place by MSH’s HIV–PBF Project, is an approach to health care financing that shifts attention and funding from resources used to results achieved. To help manage financing based on performance, MSH worked with the Government of Rwanda to design a password-protected website. It serves both as a resource for performance information and an entry point for a national database of contracts and indicators to measure the quality and quantity of basic health care and HIV & AIDS services.
Because the accessibility of such information heightens openness about funding, results, and the use of donor resources, it has fostered a spirit of healthy competition and collaboration that is rare in resource-constrained settings like Rwanda. Database users enter and monitor their own progress against agreed-upon targets, but they also see the progress of and payment to other participating health facilities.
People at each health facility are trained to use the relatively simple database and interpret the data. Depending on local Internet and computer access, participants might use their facility’s resources to submit data, or they might log on at an Internet café. Data are cross-checked and verified at several points before payments are directly deposited into health facilities’ bank accounts.
The performance-based financing system, which the HIV-PBF Project has fine-tuned since its launch in late 2006, has demonstrated that a web-based monitoring system can be effectively implemented in settings with limited infrastructure.
The Government of Rwanda has made this contractual approach to financing the cornerstone of far-reaching health care financing reforms. Together with voluntary community health insurance schemes (mutuelles) and a new quality assurance policy, performance-based financing is increasing the quantity, quality, and efficiency of HIV & AIDS and basic health services in Rwanda. When well implemented, this approach to financing leads to better distribution of resources to facilities and, most important, improved health among the people served.
Performance-based financing, as put in place by MSH’s HIV–PBF Project, is an approach to health care financing that shifts attention and funding from resources used to results achieved. To help manage financing based on performance, MSH worked with the Government of Rwanda to design a password-protected website. It serves both as a resource for performance information and an entry point for a national database of contracts and indicators to measure the quality and quantity of basic health care and HIV & AIDS services.
Because the accessibility of such information heightens openness about funding, results, and the use of donor resources, it has fostered a spirit of healthy competition and collaboration that is rare in resource-constrained settings like Rwanda. Database users enter and monitor their own progress against agreed-upon targets, but they also see the progress of and payment to other participating health facilities.
| The impact of performance-based financing in Gicumbi District in Rwanda has been dramatic. For instance, in just nine months of 2006–07, participating health centers increased the number of HIV tests administered by 155 percent (on average) to 7,670. All else kept equal, the U.S. Government will have paid less than $6.14 for each HIV test in Gicumbi. In terms of payment for results, this is a savings of $7.16 (53 percent) per test. |
People at each health facility are trained to use the relatively simple database and interpret the data. Depending on local Internet and computer access, participants might use their facility’s resources to submit data, or they might log on at an Internet café. Data are cross-checked and verified at several points before payments are directly deposited into health facilities’ bank accounts.
The performance-based financing system, which the HIV-PBF Project has fine-tuned since its launch in late 2006, has demonstrated that a web-based monitoring system can be effectively implemented in settings with limited infrastructure.
The Government of Rwanda has made this contractual approach to financing the cornerstone of far-reaching health care financing reforms. Together with voluntary community health insurance schemes (mutuelles) and a new quality assurance policy, performance-based financing is increasing the quantity, quality, and efficiency of HIV & AIDS and basic health services in Rwanda. When well implemented, this approach to financing leads to better distribution of resources to facilities and, most important, improved health among the people served.