Impact of implementing performance-based financing on childhood malnutrition in Rwanda

Abstract

BackgroundMalnutrition remains a serious concern in Rwanda, particularly among children under-5 years. Performance-based financing (PBF), an innovative health systems financing strategy, has been implemented at the national level since 2008. This study aimed to assess the impact of PBF and other factors associated with the prevalence of three classifications of malnutrition (stunting, wasting and underweight) in children under-5 years in Rwanda.MethodsThe study is a cross-sectional study comprising of 713 children under five years old from 557 households, whose anthropometric measurements (height, weight and age) had been obtained as part of the 2008 Rwanda General Health and HIV household survey. Z-scores for height-for-age, weight-for-age, weight-for-height, and body mass index-for-age were analyzed according to the World Health Organization 2006 Child Growth Standards. Random intercept logistic regression models were used to regress each anthropometric measure (WAZ, HAZ and WHZ) against child, maternal and household characteristics.ResultsChild participants ranged in age from 0 to 60 months, 20.2% of children were under 12 months and 5.1% were HIV positive. The prevalence of wasting was 8.8%; of stunting was 58.4%; and of underweight status was 20.7%. Maternal emotional and social wellbeing was protective of wasting in children under-5 years of age. Living in districts implementing PBF was protective of wasting (Adjusted Odds Ratio: 0.43; 95% confidence interval: 0.19-0.97). Living in a district with PBF was not found to be associated with either stunting or underweight status among children under-5.ConclusionsPBF may have a protective association with particular forms of malnutrition among children under-5 years in Rwanda. These findings warrant further investigation in relation to the impact of implementing innovative financing schemes on health outcomes.

Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience

“…The HIV program particularly benefited from the implementation of PBF, since payments were given for several key HIV care indicators, including the number of new adults and infants on ART, the number of HIV-positive pregnant mothers put on ART during pregnancy, and the number of HIV patients who receive a CD4 test in accordance with national guidelines. The program has been shown to have an effect on several health outcomes and it continues to be empirically evaluated and discussed in the literature [ 16 , 17 ].…”

Community-Based Health Financing and Child Stunting in Rural Rwanda

“…35 In the same year, pay-for-performance was scaled up at the national level to improve the quality of care provided by health facilities. 29 In 2009, the National Protocol on Management of Malnutrition was enacted in health facilities and the National Emergency Program to Eliminate Malnutrition (NEPEM) was launched to eliminate all forms of undernutrition in Rwanda, especially stunting, with a community-based nutritional intervention approach. 49 Children aged 6 to 24 months in the RDHS 2010 survey (born in 2008 or later) could enjoy the increased and improved nutrition care provided by rural health centers during their critical window of opportunity.…”

“…19,28 A few studies have discussed the possible link between Mutuelles enrollment and health outcomes, but without supporting empirical evidence. 29,30 In this study, taking advantage of the 2010 Rwanda Demographic and Health Survey (RDHS 2010) and the 2010 District Health System Strengthening Tool (DHHST), we determined the availability of nutritional services in the MSP of Mutuelles across rural health centers in Rwanda and conducted the first empirical study at the individual level that quantifies the association between Mutuelles enrollment and the likelihood of being stunted for rural children.…”

Race to the Top: evaluation of a novel performance-based financing initiative to promote healthcare delivery in rural Rwanda

“…Under this model of PBF, payment was made directly to health facilities based on progress toward achieving pre-determined targets to incentivize health providers as well as reward successful health centers with resources for further improving infrastructure and operations. A number of studies have demonstrated positive impacts of this strategy, such as increased uptake of maternal and child health services (9–11). …”