title: Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: a 5-year experience.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  PBF proves to be a promising approach in strengthening and maintaining quality service delivery in the sub-Saharan district hospitals.
authors.affiliation: MD, MPH, International Technical Assistant, Belgian Development Agency BTC, Rwanda.
authors.forename: Willy
authors.initials: W
authors.lastname: Janssen
authors.affiliation: MD, MPH, MSc, PhD, Head of Institute of HIV/AIDS, Disease Prevention & Control. Rwanda Biomedical Center, Rwanda.
authors.forename: Jean de Dieu
authors.initials: Jde D
authors.lastname: Ngirabega
authors.affiliation: MPH, PBF M&E Expert, Ministry of Health, Rwanda.
authors.forename: Michel
authors.initials: M
authors.lastname: Matungwa
authors.affiliation: MD, MMed, MPH, Senior Health Expert, Belgian Development Agency BTC, Rwanda, Belgium stefaan.vanbastelaere@btcctb.org.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Van Bastelaere
mesh_terms: D005381:Financing, Organized / Q000191:economics*; D006767:Hospitals, District / Q000592:standards*; D006801:Humans; D009313:National Health Programs / Q000191:economics; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012432:Rwanda
keywords: Performance-based financing; Rwanda; clinical activities; district hospital; health centre support; hospital management; peer-evaluation; quality improvement; self-assessment