ArticleGlobal health action
Race to the Top: evaluation of a novel performance-based financing initiative to promote healthcare delivery in rural Rwanda.
Article in Global health action. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries.Global health, science and practice · 2020Pooled it
- The complexity of inequity: rethinking global health through lived experience, power, and structural vulnerability.International journal for equity in health · 2026Article
- Health economics in Africa: historical perspectives, current challenges, and policy recommendations for sustainable healthcare financing and resource allocation.Cost effectiveness and resource allocation : C/E · 2026Review
- Using performance-based grants to subnational governments to improve health outcomes: a repeated cross-sectional evaluation of the Saving One Million Lives Programme in Nigeria.BMJ public health · 2026Article
- Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda.Surgical infections · 2023Article
- Can payment by results ensure equitable access to contraceptive services? a qualitative case study.International journal for equity in health · 2023Article
- Use of implementation science to advance family planning programs in low- and middle-income countries: A systematic review.Frontiers in global women's health · 2022Review
- Article
- Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach.International journal of health policy and management · 2018Article
- Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia.BMC health services research · 2017Article
- Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative.BMC health services research · 2017Article
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9 authors.
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Abstract
backgroundPerformance-based financing (PBF) has demonstrated a range of successes and failures in improving health outcomes across low- and middle-income countries. Evidence indicates that the success of PBF depends, in large part, on the model selected, in relation to a variety of contextual factors.
objectivePartners In Health∣Inshuti Mu Buzima aimed to evaluate health outcomes associated with a novel capacity-building model of PBF at health centers throughout Kirehe district, Rwanda.
designThirteen health centers in Kirehe district, which provide healthcare to a population of over 300,000 people, agreed to participate in a PBF initiative scheme that integrated data feedback, quality improvement coaching, peer-to-peer learning, and district-level priority setting. Health centers' progress toward collectively agreed upon site-specific health targets was assessed every 6 months for 18 months. Incentives were awarded only when health centers met goals on all three priorities health centers had collectively agreed upon: 90% coverage of community-based health insurance, 70% contraceptive prevalence rate, and zero acute severe malnutrition cases. Improvement across all four time points and facilities was measured using mixed-effects linear regression.
findingsAt 6-month follow-up, 4 of 13 health centers had met 1 target. At 12-month follow-up, 7 centers had met 1 target, and by 18-month follow-up, 6 centers had met 2 targets and 2 centers had met all 3. Average health center performance had improved significantly across the district for all three targets: mean insurance coverage increased from 68% at baseline to 93% (
conclusionThe combining of PBF, district engagement/support, and peer-to-peer learning resulted in significant improvements despite resource constraints and is now being considered as a model for scale-up in other districts of Rwanda.
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