Strengthening Healthcare Systems in Resource Poor Areas: Performance Based Financing in Burundi and Rwanda

Performance Based Financing (PBF) is a public health policy used to motivate public and private healthcare providers through the use of financial incentives in relation to returns on agreed outputs. It aims to increase... [ view full abstract ]

Performance Based Financing (PBF) is a public health policy used to motivate public and private healthcare providers through the use of financial incentives in relation to returns on agreed outputs. It aims to increase accessibility, efficiency, equity, quantity and quality of health services. Furthermore, it solves the principal-agent problem in healthcare administration bridging management and result oriented services. Performance Based Financing was introduced both in Burundi and Rwanda to increase health worker’s productivity, accountability and boost the performance and quality of healthcare delivery. This program required new Institutional frameworks which includes four major parts: regulator, provider, PBF steering committee and local fund holder. PBF was deemed to be very successful especially on maternal and child care. However, the results might have been clouded by the new national health insurance program in Rwanda and free maternal and child care in Burundi. PBF is very donor dependent for financial support, for capacity building and to establish the adequate preconditions for scale up. This program does not address all the pitfalls of the Burundian and Rwandan public health system but draws attention to certain aspect of healthcare in an underpaid and overstretched public health context.