Performance‐based financing for better quality of services in Rwandan health centres: 3‐year experience

Abstract

SummaryIn 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.

Quality of Care in Performance-Based Financing: How It Is Incorporated in 32 Programs Across 28 Countries

“…For instance, register and patient record reviews may be less costly, but the quality data may vary. In Rwanda, patient record review, verified by qualified supervisors, were considered a valuable quality criterion, resulting in systemic improvements in data collection, monitoring, and supervision that contributed far more to the quality improvements than service delivery improvements 14 . Direct observations may yield good quality at relatively higher cost.…”

Local stakeholders’ perceptions about the introduction of performance-based financing in Benin: a case study in two health districts

“…We make no judgement about the WB and BTC approaches, but take them for granted and try to appreciate how stakeholders make it happen and implement that policy, what it becomes on the ground and how it behaves in stakeholders' perception. While to date, most evaluations of PBF in developing countries aimed either to describe and compare designs (17) or to assess its impact over health results indicators (18,19), a group of academics and PBF practitioners recently developed a more comprehensive framework for monitoring and evaluating PBF, aimed at analysing its interactions with health systems. It is structured around five domains of: (i) context and its influences on PBF; (ii) development process; (iii) design; (iv) implementation; and (v) effects on health systems (3).…”

“…It was developed through a participative, bottom-up approach, thus BTC built on that experience to design its approach, in an action-research dynamic. As for the WB, it mainly built on the successful and well-documented Rwandan experience (18,19). In the two visited districts, field actors regret not having been consulted during PBF policy formulation.…”

Implementation and Operational Research: Evolution of Couples' Voluntary Counseling and Testing for HIV in Rwanda: From Research to Public Health Practice

“…51 To pilot this procedure, PSF counselors trained and supported government staff in several clinics in Kigali to provide weekend CVCT (as had been done in the WAF study in 2001 described above), with the goal of transitioning the procedures to weekday ANC services. According to the performance-based financing system, 52,53 the MoH paid clinics for services rendered. It quickly became clear to clinic managers and staff that counseling 2 people jointly required far less time than counseling them as individuals, and that CVCT was thus time and cost saving.…”