Rwanda: Performance-Based Financing Contributes to Improved Health Services

[A laboratory worker at Kabusunzu Health Center in Kigali, Rwanda. Photo Credit: Tempe Goodhue.]A laboratory worker at Kabusunzu Health Center in Kigali, Rwanda. Photo Credit: Tempe Goodhue.Rewarding health service providers in Rwanda for positive results has increased the number of clients served and improved the quality of the services they receive. MSH has documented noteworthy gains in indicators of maternal-child health from 2005 through mid-2009.

A sampling at 286 health centers shows that the average number of assisted births per facility rose from 28 to 40 per month, an increase of 43 percent (figure 1). Skilled providers now attend more than half of all deliveries in Rwanda.

{Figure 1.}Figure 1.

In a country where between 3.0 percent (rural) and 8.6 percent (urban) of women are HIV positive, the average number of HIV-positive women per health center using family planning grew from 12 to 30 monthly, an increase of 158 percent. The use of contraception not only improves the health of mothers and infants—through healthy timing and spacing of pregnancies—but also helps prevent the transmission of HIV.

Growth monitoring, a principal method of assessing child health and reducing child mortality, increased on average from 237 to 547 children per month, a 131 percent jump, as Figure 1 shows. The results from 286 health centers also demonstrate that quality has climbed steadily across all technical areas that were evaluated (figure 2).

{Figure 2.}Figure 2.

With support from the US Agency for International Development and MSH, performance-based financing (PBF) was gradually put in place in all 30 districts of Rwanda. Today all 406 health centers and 40 district hospitals are participating.

Through PBF, health facility directors receive incentive payments directly and decide how they will use the money. They may buy new equipment, expand services, augment staff members’ pay, or address some other need that falls within Government of Rwanda guidelines and that will improve their results—and increase future payments.

The future looks brighter for Rwanda’s citizens because of the government’s commitment to sustaining these advances in health care, including PBF. Read More.

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