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 centers (HC) and district hospitals (DH). In 2008 PBF became national strategy.


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. The authors studied four DHs.


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.


PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals.

Resource Information

Author/s: Willy Janssen, Jean de Dieu Ngirabega, Michel Matungwa, Stefaan Van Bastelaere
Publication ID: doi: 10.1177/0049475514554481
Countries: Rwanda
Date of Publication: January 2015

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