Rwanda Performance-Based Financing
Country of Operation
- Ministry of Health, RwandaGovernment
SummaryPay-for-performance is a program in which patients, individual providers, or health organisations are rewarded with money or material goods if they take certain actions.
By contrast with traditional global health funding, in which governments and donors pay for inputs (eg, salaries), pay-for-performance pays for outputs (eg, the number of facility-based births). This program hopes to increase the number of institutionalized births in Rwanda through this technique.
Key program components
Performance-based financing (PBF) was first rolled out in Rwanda in 2001, propelled by a notable stagnation in the outputs of health services and encouraged by successful pilots of similar contracting schemes in places such as Cambodia.
The first PBF schemes in Rwanda were implemented by Memisa/Cordaid in Cyangugu province in 2001, by HealthNet International (HNI) in Butare in 2002, and by the Belgian Technical Cooperation (BTC) in 2005. The pilots were judged successful and in 2005, with technical assistance from USAID, BTC, Cordaid, HNI and the WB, the country's Ministry of Health designed a plan to implement PBF schemes in all health facilities in Rwanda. Three key steps were undertaken to operationalize this scale-up:
(1) Adopting an institutional framework,
(2) Developing the performance-based model and necessary tools
(3) Designing an implementation plan and an impact evaluation. The new national PBF model was rolled out in Health Centers across 23 districts in July of 2006 and in District Hospitals in December of that year.