MSH at Clinton Global Initiative: Innovative Performance-Based Financing Improves Health Care for Millions in Rwanda and Haiti

Clinton Global Initiative: September 22-25, 2009

(New York, NY) Management Sciences for Health (MSH) today reported that the first year of its four-year $12.5 million CGI Commitment to Action to introduce and expand performance-based financing (PBF) has resulted in dramatically improved quality and delivery of health services for millions of people in Rwanda and Haiti. PBF empowers health managers to allocate resources in a way that rewards meeting health goals. By improving financial management capacity and expertise, PBF strengthens the sustainability and performance of ministries of health, district and community institutions, and NGOs.

Notably, the PBF program in Rwanda contributed to: doubling deliveries in health centers (from approximately 23% in 2006 to 42% in 2008); reducing neonatal and maternal mortality; doubling the monitoring of child growth and nutritional status; and doubling vaccinations for pregnant women to protect them from tetanus. The MSH PBF program also accelerated an increase in Rwandan health center quality scores by 20 points on a scale of 100, including increases in quality of general management, health center cleanliness, and the overall quality of outpatient, obstetric, family planning, vaccination, nutrition, and HIV/TB clinics. 

In Haiti, MSH expanded PBF into the public sector and enhanced community- based services to improve access to health services. In 2008, nearly 4,000,000 people (43% of the population) were reached by SDSH (Santé Pour le Développement et la Stabilité d’Haïti) with 147 service delivery points in all 10 geographical departments. More than $6 million was secured in leveraged contributions from the private sector with about $10 million more expected by September 2010. A new deworming project, support for nutrition programs, and inventory and distribution system were launched in August 2009.

“Performance-based financing is a powerful means of expanding access to high-quality, efficient health care services by providing incentives to providers and facilities for improved results, “ said Dr. Jonathan D. Quick, President & CEO of MSH. “In pursuit of the Millennium Development Goals and the fundamental human right to universal access to quality health care, PBF can increase use and quality of health care services, stabilize or decrease costs, help use limited resources effectively, and improve staff motivation and morale—a proven incentive for retention of health workers,” said Dr. Quick. A community PBF program, reaching thousands of Rwandans, was launched in 2009 by the Ministry of Health (MOH) with MSH support to help address the human resources for health shortage by training cadres of five Community Health Workers (CHW) per village to provide basic primary health care services. Rwandan President Kagame launched the program formally at a public event with 37,000 CHW present (eventually there will be 60,000 CHW involved in the program). 

“The community PBF program will impact rural populations, improve engagement in and support to the health system for over two million people and will greatly strengthen community involvement in efforts to control HIV & AIDS and TB,” said John Pollock, MSH Global Technical Lead, Health Delivery Systems and Senior Fellow for Health Reform and Finance.

MSH’s partners in the CGI Commitment to Action are:

In Rwanda: the Government of Rwanda Ministry of Public Health; the Belgian Technical Cooperation; and US Agency for International Development

In Haiti: the Government of Haiti Ministry of Health, the US Agency for International Development, private voluntary organizations, and private commercial sectors. MSH is currently also working in Ethiopia to use PBF as a strategy to scale up HIV and tuberculosis testing and treatment services to 500 health centers nationwide. For more than a decade, MSH has designed, implemented, and supported innovative PBF for health programs. Successes include dramatic and sustained improvements in immunization rates and reduced infant mortality. MSH has supported PBF initiatives in 14 countries. 

For more on MSH and Performance-Based Financing

 

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