Performance Based Financing

In an earlier blog post on data recording, I mentioned Rwanda’s use of the performance based financing system, which has been largely praised by the international community. Because I obviously think my opinion is more important than that of the United Nations, the World Health Organization, Rwanda’s Ministry of Health, and hundreds of International NGO’s and think tanks, I would like to inform you all that I too, am ready to praise Performance Based Financing; and that the Peace Corps is turning me into a staunch supporter of capitalism, free market enterprise, and fiscally conservative social policy (sort of).  

wedding guests arrive (Gitarama District)

Traditionally, governments and international organizations have funded inputs in developing countries. That is to say, money is given to build facilities, pay doctors, purchase medicine—results are assumed to follow suit. But decades and billions of dollars later, malaria has not been eradicated and many of my neighbors still opt to give birth at home.

Performance Based Financing (PBF) rewards health care providers (like my health center staff or the community health workers’ cooperative) for work they have already done. Money, proportional to the quantity and quality of the job, is given after results are reported. Then, the people who delivered the results decide what to do with the money.

The staff meetings where PBF is discussed can get pretty heated. My health center happens to be the worst performing of the district, and the bonuses reflect it. For months I’ve been trying to talk to staff about giving pregnant women iron and folic acid tablets (which are required by national policy). No one seemed to care until the PBF report came back criticizing the low attendance at prenatal consultations. Suddenly everyone was brainstorming how to get pregnant women to the health center. Three months later, I now help distribute the vitamin supplements during prenatal consultations and am happy to report that the number of women coming for consults during their first trimester has increased!