Efficiency of HIV/AIDS health centers and effect of community-based health insurance and performance-based financing on HIV/AIDS service delivery in Rwanda

Am J Trop Med Hyg. 2014 Apr;90(4):740-746. doi: 10.4269/ajtmh.12-0697. Epub 2014 Feb 10.


This study evaluates the efficiency of rural health centers in Rwanda in delivering the three key human immunodeficiency virus/acquired immunodeficiency syndrome services: antiretroviral treatment, prevention of mother-to-child transmission, and voluntary counseling and testing using data envelopment analysis, and assesses the impact of community-based health insurance (CBHI) and performance-based financing on improving the delivery of the three services. Results show that health centers average efficiency of 78%, and despite the observed variation, the performance increased by 15.6% from 2006 through 2007. When the services are examined separately, each 1% growth of CBHI use was associated with 3.7% more prevention of mother-to-child transmission and 2.5% more voluntary counseling and testing services. Although more health centers would have been needed to evaluate performance-based financing, we found that high use of CBHI in Rwanda was an important contributor to improving human immunodeficiency virus/acquired immunodeficiency syndrome services in rural health centers in Rwanda.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / transmission
  • Adult
  • Antiretroviral Therapy, Highly Active / methods*
  • Child
  • Community Health Services / economics
  • Community Health Services / methods*
  • Counseling
  • Delivery of Health Care / economics
  • Delivery of Health Care / methods*
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / transmission
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control
  • Insurance, Health / economics
  • Male
  • Pregnancy
  • Regression Analysis
  • Reimbursement, Incentive / economics
  • Residence Characteristics
  • Rural Health Services* / economics
  • Rwanda