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

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.