Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: a 5-year experience

Trop Doct. 2015 Jan;45(1):27-35. doi: 10.1177/0049475514554481. Epub 2014 Nov 17.


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.

MeSH terms

  • Financing, Organized / economics*
  • Hospitals, District / standards*
  • Humans
  • National Health Programs / economics
  • Quality Assurance, Health Care*
  • Retrospective Studies
  • Rwanda