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Impact of Performance Based Financing in Rwanda: Health Facility Level Analysis

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Name of the Asset | Impact of Performance Based Financing in Rwanda: Health Facility Level Analysis
Type of Asset | Working Paper
Date | November 2009


The 1994 genocide decimated Rwanda’s fragile economic base, destroyed a large share of the country’s human capital, including healthcare. Rwanda implemented performance-based financing (PBF) at the national scale in 2006 for maternal and child health care services. The purpose of this study is to assess the impact of the PBF intervention on the maternal and child health service in Rwanda.

The study provides strong evidence from a rigorous impact evaluation design on the net effect of PBF intervention on the quantity and quality of maternal health services in poor country settings. Estimating both the net effect of quantity and key maternal and child services fill an important gap in the scientific literature as no study has yet been published on this specific topic.

Findings show that higher payments provided more high-powered incentive and that activities controlled by health providers rather than patients responded to these incentives. However, PBF had no potential to increase the availability of equipment and drugs at the health facilities. The study also found a significant but modest decrease in the number of underweight babies in favor of facilities receiving PBF intervention.


  • Paulin Basinga, Lecturer, National University of Rwanda School of Public Health
  • Agnes Binagwaho, Executive Secretary of Rwanda’s National AIDS Control Commission
  • Paul J. Gertler, Professor of Economics, Haas School of Business, University of California, Berkeley
  • Agnes L.B. Soucat, Senior Health Economist, The World Bank
  • Jennifer R. Sturdy, The World Bank

Christel M.J. Vermeersch, The World Bank
Country and/or Region | Rwanda
Name of the Program | GDN’s Global Research Project 'Promoting Innovative Programs from the Developing World: Towards Realizing the Health MDGs in Africa and Asia'
Funder(s) | The Bill & Melinda Gates Foundation, United States

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