Introduction: Since 2000 performance-based financing (PBF) made its way to sub-Saharan health systems in an attempt to improve service delivery. In Rwanda initial experiences in 2001 and 2002 led to a scaling up of the initiative to all health centres (HC) and district hospitals (DH). In 2008 PBF became national strategy.
Methods: PBF was introduced in Rwanda in 2006 at the DH level. Evaluation on their service delivery was carried out quarterly in the following areas: hospital management, support to the health centres and clinical activities. We studied four DHs.
Results: After 5 years, an improvement in the quantity of clinical activities was observed, as well as quality in hospital management, in HC support and in clinical activities.
Conclusion: PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals.
Keywords: Performance-based financing; Rwanda; clinical activities; district hospital; health centre support; hospital management; peer-evaluation; quality improvement; self-assessment.
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