Rwanda

Start: 2002
Phase: Started from 2002 onwards in three pilot areas, expanded to national level in 2006
Coverage Estimate: 100%
Feasibility: Successful scaling up, experience exported to other countries such as DRC and Burundi
Supported by: MOH/MOF – PEPFAR-USAID; GF; WB, Belgians and others

Description: Rwanda was the first country to introduce PBF nation wide. It was also the first in which a rigorous impact evaluation documented postive effects on quantity and quality of health services (mother and child health, but also HIV services), on the know-do gap of providers and on the nutritional status of children under five. Being the first it did not introduce all PBF best practices, but the country has been correcting some imperfections. It is a big example for many other African countries and is regularly visited by international delegations on how to apply PBF (and other health reforms such as obligatory community health insurance). An external review may be necessary to find out on problems with PBF, how to continue and how to integrate PBF in other health reform efforts. It has pioneered many successful tools such as the web-enabled application; the extended team approach; multiple fundholders paying for performance; successful public-private partnerships and others.

Reference:
Meessen, B., L. Musango, et al. (2006). “Reviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda.” TMIH 11(8): 1303-1317.

Meessen, B., J.-P. Kashala, et al. (2007). “Output-based payment to boost staff productivity in public health centers: contracting in Kabutare district, Rwanda.” Bulletin of the World Health Organization 85(2): 108-115.

Soeters, R., C. Habineza, et al. (2006). “Performance-based financing and changing the district health system: experience from Rwanda.” Bulletin of the World Health Organization 84(11).

Rusa, L. and G. Fritsche (2007). Rwanda: Performance-Based Financing In Health. Emerging Good Practice in Managing for Development Results: Sourcebook -2nd edition, the World Bank: 55-60.

Rusa, L., W. Janssen, et al. (2009). “Performance-based financing for better quality of services in Rwandan health centers: 3-year experience.” TMIH 14: 830-837.

Basinga, P., P. Gertler, et al. (2011). “Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.” The Lancet 377: 1421-1428.

Basinga, P., P. Gertler, et al. (2011). “Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.” The Lancet 377: 1421-1428.

Walque, D. d., P. J. Gertler, et al. (2013). Using Provider Performance Incentives to Increase HIV Testing and Counseling Services in Rwanda. Policy Research Working Paper No 6364. Washington DC, The World Bank.

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