Contract Services/organization & administration; Female; Financing, Organized/organization & administration; Health Care Reform/organization & administration; Health Services Accessibility/organization & administration; Health Services Administration; Humans; Male; National Health Programs/economics/organization & administration; Quality Assurance, Health Care/economics/organization & administration; Rwanda
Abstract :
[en] In 2005, the Ministry of Health in Rwanda, with the support of the Belgian Technical Cooperation, launched a strategy of performance-based financing (PBF) in a group of 74 health centres (HCs), covering 2-m inhabitants. In 2006, PBF was extended to an additional group of 85 HCs, thus reaching 3.8-m inhabitants. This study evaluates the effect of PBF on HC performance from 2005 to 2007. Composite indicators for measuring quantity and quality of services were developed and evaluated through monthly formative supervisions by qualified and well-trained district supervisors. The strategy was based on a fixed fee per quality-approved service. The entire budget spent on the implementation of PBF amounted to $0.25/cap/year, of which $0.20/cap/year for subsidies and an estimated $0.05/cap/year for administration, supervision and training. A positive effect on utilization rates was only seen for activities that were previously less well organized; in this case, growth monitoring services and institutional deliveries. The quality of services, defined as the compliance rate with national and international norms, rose considerably for all services in both groups. A sustained level of quality between 80% and 95% was reached within 18 months in the first group. A similar result was reached in the second group in 8 months.
Disciplines :
General & internal medicine
Author, co-author :
Rusa, Louis
Ngirabega, Jean De Dieu
Janssen, Willy
Van Bastelaere, Stefaan
Porignon, Denis ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Vandenbulcke, Werner
Language :
English
Title :
Performance-based financing for better quality of services in Rwandan health centres: 3-year experience.
Mathauer I Imhoff I (2006) Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Human Resources for Health 4, 24.
Meessen B, Musango L Kashala JP (2006) Output-based payment to boost staff productivity in public health centers: contracting in Kabutare district, Rwanda. Bulletin of the World Health Organization 85, 108 115.
MoH (2007) Interim Demographic Health Survey. MoH, Rwanda.
Rowe AK, de Savigny D, Lanata CF Victora CG (2005) How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet 366, 1026 1035.
Soeters R, Habineza C Peerenboom PP (2006) Performance-based financing and changing the district health system: experience from Rwanda. Bulletin of the World Health Organization 84, 884 889.
WHO (2003) The Role of Contractual Arrangements in Improving Health Systems' Performance. Fifty-sixth World Health Assembly 2003, WHA56.25 Agenda Item 14.13. WHO, Geneva.
WHO (2005) Application of Contracting in Health Systems: Key Messages. Technical Briefs for Policy Makers.