Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: A 5-year experience

Janssen, Willy; Ngirabega, Jean de Dieu; Matungwa, Michel; Bastelaere, Stefaan Van

doi:10.1177/0049475514554481

Cited by 31 publications

(31 citation statements)

References 7 publications

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“…The system is now managed by the MoH 25 and is associated with an improvement in nationwide health service uptake. 17,19 One stakeholder noted concern about possible coercion if LARC methods were reimbursed differently, a concern also raised by USAID. 26 However, differentiated reimbursement schemes, proportional to the time and costs that clinics incur to provide LARC methods, have been considered and implemented in other locales, for example in Burundi where the payment for new oral and injectable FP users and all return clients was $2.00USD, while for implants/IUDs it was $5.00USD.…”

Section: Discussionmentioning

confidence: 99%

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Rwandan stakeholder perspectives of integrated family planning and HIV services

Wall

Bayingana

Ingabire

et al. 2018

Health Planning & Management

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SummaryThe purpose of this qualitative study was to understand the knowledge, attitudes, and practices among key Rwandan policymakers and stakeholders related to family planning (FP) and integrated HIV/FP services. Motivational in-depth interview format and content was developed after an extensive policy review. A convenience sample of 10 high-level HIV and FP Rwandan policymakers and stakeholders completed the interview. Stakeholders demonstrated strong foundational knowledge of HIV and FP. Given the choice, stakeholders would allocate more monies to FP and less to HIV than currently distributed. Respondents felt that improved FP method knowledge, especially long-acting reversible contraception, among clients/couples and providers, was needed to address myths, misconceptions, and biases. The most often cited way to integrate HIV/FP services was development of integrated tools (eg, training materials, data collection tools, and advocacy and policy guidance). We recommend strategies for policy advancement supportive of HIV/FP service integration inclusive of couples and long-acting reversible contraception methods.

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Section: Discussionmentioning

confidence: 99%

“…Respondents were also asked to select from a list of options to enhance LARC uptake, including modification to Rwanda’s performance-based financing system which currently reimburses facilities for new contraceptive method users. 17–19 …”

Section: Methodsmentioning

confidence: 99%

Rwandan stakeholder perspectives of integrated family planning and HIV services

Wall

Bayingana

Ingabire

et al. 2018

Health Planning & Management

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“…Aside from these difficulties, the evaluation found that hospitals were able to achieve high-quality scores quickly, which prompted two revisions of the evaluation grid over three years in order to make the evaluation criteria more specific, precise, and measurable and to adapt to changing needs observed at hospitals. 24 This finding may be helpful for designers and managers of future quality measurement initiatives to consider when rolling out a new system that can promote continuous quality improvement.…”

Section: How the Provider Payment Initiative Improved Quality Of Matementioning

confidence: 95%

“…23 In Rwandan hospitals, the payment initiative helped to clarify the responsibilities and roles of all parties involved in the production, monitoring, and evaluation of health services, although it was unclear whether this clarification led to an improvement in quality. 24 The evaluation of the payment initiative in Senegal reported strengthened leadership of health post directors, increased involvement of community health workers, more transparent financial management of the facility, and improved recording and monitoring of services provided. 25 These evaluations did not seek to measure the direct correlation between improvements in patient outcomes with such observed management results, so results should be interpreted with caution.…”

Section: How the Provider Payment Initiative Improved Quality Of Matementioning

confidence: 99%

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A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries

Wright

Eichler

2018

Health Systems & Reform

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Abstract-To reduce maternal and newborn morbidity and mortality, health care payers are experimenting with ways to better align incentives to promote high-quality maternal health services. This review examined 26 recent initiatives of health care payers in 16 low-and middle-income countries to pay for quality, and not solely quantity, of maternal health services. Payers measured quality by assessing availability of structural inputs (24 of 26 cases), adherence to processes (25 of 26 cases), and observation of key outputs of health facilities (14 of 26 cases). Two payers sought to also assess quality through observed patient outcomes. In 25 of the initiatives, payers used the quality assessment to adjust facility payments; in the remaining initiative, the payer used the quality assessment to adjust payments to provincial governments, which in turn pay facilities. The recent growth in such payment systems suggests more health care payers have identified ways to link quality measurement with provider payment mechanisms. Eleven impact evaluations of systems documented changes in provider behavior consistent with various elements of quality; however, only three evaluations reported effects on maternal or newborn morbidity and mortality and do not conclude whether the design or flaws in how it was implemented led to the results. Implementation fidelity-the degree to which the initiative was implemented as designed-was not widely addressed and is an area for future research. Furthermore, although payers in low-and middle-income countries have identified ways to operationalize a payment system that adjusts payments based on some measure of quality, the complexity and level of resources required to operationalize them raise concerns about sustainability.

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Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Diaconu

Falconer

Verbel

et al. 2021

Cochrane Database of Systematic Reviews

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Background There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low‐ and middle‐income countries (LMICs) is lacking; this is an update of the 2012 review on this topic. Objectives To assess the effects of paying for performance on the provision of health care and health outcomes in low‐ and middle‐income countries. Search methods We searched CENTRAL, MEDLINE, Embase, and 10 other databases between April and June 2018. We also searched two trial registries, websites, online resources of international agencies, organizations and universities, and contacted experts in the field. Studies identified from rerunning searches in 2020 are under 'Studies awaiting classification.' Selection criteria We included randomized or non‐randomized trials, controlled before‐after studies, or interrupted time series studies conducted in LMICs (as defined by the World Bank in 2018). P4P refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: patient health outcomes, changes in targeted measures of provider performance (such as the delivery of healthcare services), unintended effects, or changes in resource use. Data collection and analysis We extracted data as per original review protocol and narratively synthesised findings. We used standard methodological procedures expected by Cochrane. Given diversity and variability in intervention types, patient populations, analyses and outcome reporting, we deemed meta‐analysis inappropriate. We noted the range of effects associated with P4P against each outcome of interest. Based on intervention descriptions provided in documents, we classified design schemes and explored variation in effect by scheme design. Main results We included 59 studies: controlled before‐after studies (19), non‐randomized (16) or cluster randomized trials (14); and interrupted time‐series studies (9). One study included both an interrupted time series and a controlled before‐after study. Studies focused on a wide range of P4P interventions, including target payments and payment for outputs as modified by quality (or quality and equity assessments). Only one study assessed results‐based aid. Many schemes were funded by national governments (23 studies) with the World Bank funding most externally funded schemes (11 studies). Targeted services varied; however, most interventions focused on reproductive, maternal and child health indicators. Participants were predominantly located in public or in a mix of public, non‐governmental and faith‐based facilities (54 studies). P4P was assesse...

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Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: A 5-year experience

Abstract: PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals.

Cited by 31 publications

References 7 publications

Rwandan stakeholder perspectives of integrated family planning and HIV services

Rwandan stakeholder perspectives of integrated family planning and HIV services

A Review of Initiatives that Link Provider Payment with Quality Measurement of Maternal Health Services in Low- and Middle-Income Countries

Paying for performance to improve the delivery of health interventions in low- and middle-income countries

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