Community Performance-based Financing Increases Safe Deliveries in Rwanda

Dativa is a mother of two living in eastern Rwanda. Her first baby was born at home; she felt that the health center was too far away. During her second pregnancy, a community health worker encouraged Dativa to deliver at the health center. When Dativa went into labor, she took the advice. The community health worker helped her to take a motorcycle taxi to the nearest health center at Nzige, which would normally be a 90-minute walk.

Dativa was examined by an experienced nurse who quickly detected a fetal malposition, which required urgent transfer to the district hospital. She was immediately transferred by a well-equipped ambulance to the Rwamagana district hospital. At the hospital, a skilled physician performed a cesarean section, and her baby received emergency treatment. These interventions saved Dativa and her baby’s life.

Launched in 2009, Rwanda’s community-based performance-based financing (PBF) scheme has greatly increased the utilization of health services. In 2005, 70 percent of Rwandan women delivered at home. In 2010, 70 percent of deliveries occurred in health facilities with qualified personnel.

Much of this increase can be attributed to community health workers, who now receive financial incentives for their work —including for accompanying laboring women to facilities. Before PBF was introduced, community health workers were less likely to take time away from their own families.

The USAID Integrated Health Systems Strengthening Project (IHSSP), managed by Management Sciences of Health (MSH), helped develop and implement these programs, supporting the Rwandan health managers with training, assistance, and tools.

Davita is thankful to the community health worker; without his advice, she likely would have delivered at home and died because of complications during delivery. Today Dativa and her baby girl are in good health.