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

• Published in: Global health action 2016-12, Vol.9 (1), p.32943-32943
• Main Authors: Nahimana, Evrard, McBain, Ryan, Manzi, Anatole, Iyer, Hari, Uwingabiye, Alice, Gupta, Neil, Muzungu, Gerald, Drobac, Peter, Hirschhorn, Lisa R.
• Format: Article
• Language: English
• Subjects: capacity building; Capacity building approach; Coaching; Community health care; competition; Contraceptives; Financing; Health care delivery; Health facilities; Health insurance; Health status; Incentives; Initiatives; Insurance coverage; Malnutrition; Original; priority setting; Quality management; Race; results-based financing; Rural communities; Rwanda
• ISSN: 1654-9716; 1654-9880
• DOI: 10.3402/gha.v9.32943

Performance-based financing (PBF) has demonstrated a range of successes and failures in improving health outcomes across low- and middle-income countries. Evidence indicates that the success of PBF depends, in large part, on the model selected, in relation to a variety of contextual factors. Partners In Health∣Inshuti Mu Buzima aimed to evaluate health outcomes associated with a novel capacity-building model of PBF at health centers throughout Kirehe district, Rwanda. Thirteen health centers in Kirehe district, which provide healthcare to a population of over 300,000 people, agreed to participate in a PBF initiative scheme that integrated data feedback, quality improvement coaching, peer-to-peer learning, and district-level priority setting. Health centers' progress toward collectively agreed upon site-specific health targets was assessed every 6 months for 18 months. Incentives were awarded only when health centers met goals on all three priorities health centers had collectively agreed upon: 90% coverage of community-based health insurance, 70% contraceptive prevalence rate, and zero acute severe malnutrition cases. Improvement across all four time points and facilities was measured using mixed-effects linear regression. At 6-month follow-up, 4 of 13 health centers had met 1 target. At 12-month follow-up, 7 centers had met 1 target, and by 18-month follow-up, 6 centers had met 2 targets and 2 centers had met all 3. Average health center performance had improved significantly across the district for all three targets: mean insurance coverage increased from 68% at baseline to 93% (p