This is a continuing activity from FY 2007. No narrative required.

This is a continuing activity from FY 2007.

PBF is an innovative approach to financing health services based on output that enhances quality of

services and leads to greater efficiency and sustainability. Output financing involves the purchase of a

certain quantity of indicators with a performance incentive for the production of more than agreed upon

quantities of services. Full or proportionally reduced payment of HIV/AIDS indicators is determined by the

quality of general health services as measured by the score obtained using the standardized national

Quality Supervision tool. Financial incentives provided by PBF to motivate health facilities to improve

performance through investments in training, equipment, personnel and payment systems that better link

individual pay to individual performance. PBF is directly applied to HIV/AIDS indicators at the facility level.

As a result of successful pilots implemented by CordAID, GTZ and BTC, the MOH has endorsed national

scale-up of PBF for all health services. The EP, in partnership with the World Bank, BTC and other donors,

is supporting national implementation of PBF and health services.

In FY 2007, MSH/PBF supported the GOR in collaboration with key donors to implement a national

strategy, policy, and model of PBF that applies to all health assistance and provided out-based financing to

health facilities in six districts through direct performance sub-contracts with health centers and district

hospitals for HIV/AIDS indicators. The EP adopted a strategy in FY 2007 to combine both input and output

financing to properly motivate health facilities for higher performance while providing necessary resources

and tools to meet the established targets. While PBF clearly increases performance, TA and basic input

support is still needed, especially in the current context of rapid decentralization and accelerated national

roll-out of the PBF model by the GOR. At the health center level, EP partners purchase a quantity of

indicators with a performance incentive. Examples of basic health care indicators include the number of

HIV infected clients who tested their CD4 levels six-monthly, number of HIV infected clients treated with

CTX each month, number of HIV infected women who are using FP, and number of HIV infected clients

who have been screened for STIs. Performance on these indicators are measured during monthly control

activities jointly conducted by the MSH/PBF district coordinator, clinical partners, and the district's Family

Health Unit and quality of services is evaluated through the existing national supervisory and quality

assurance mechanisms. The quantity and quality scores are merged during the quarterly district PBF

steering committee meetings and the final payment is approved. At the district hospital level, MSH/PBF will

have sub-contracts with slightly different purpose and scope from that of health centers. In addition to the

focus on increasing quality service outputs, there is an emphasis on quality assurance, self-evaluation, and

review by peers (similar to an accreditation scheme). There is payment for indicators from the National

District Hospital PBF Scheme which reinforces the supervisory role hospitals play in district health networks.

In FY 2008, MSH/PBF will continue providing support to the MOH PBF department and the national PBF

TWG. In addition, MSH/PBF will provide TA to DHTs in all EP districts and to EP implementing partners to

effectively shift some of their input financing to output-based financing for HIV/AIDS indicators in

accordance with national policy. MSH/PBF will also provide intensive technical assistance to districts that

will be introducing PBF in FY 2008. At the District level, MSH/PBF will continue supporting the national

model by 1) placing a district coordinator within the Family Health Unit to work with national family health

steering committee during data collection/entry and control of indicators, 2) facilitating the quantity control

function by providing TA and paying associated costs, and 3) supporting secretarial functions for the Family

Health Unit at the District level. Support to the District is critical for the proper functioning of the national

PBF model since monthly HIV/AIDS invoices approved by the health center PBF management committee

and MSH are presented to the district steering committee for merging with quality index and final approval

before payments are made.

PBF of HIV/AIDS services is a critical step to achieving the goal of sustainable, well-managed, high quality,

and cost-effective basic health care service delivery in a comprehensive HIV/AIDS treatment network. This

financing modality supports the Rwanda EP five-year strategy for increasing institutional capacity for a

district managed network model of HIV clinical treatment and care services.

Performance-based financing (PBF) is an innovative approach to financing of health services based on

output that enhances quality of services and leads to greater efficiency and sustainability. Output financing

involves the purchase of a certain quantity of indicators with a performance incentive for the production of

more than agreed upon quantities of services. Full or proportionally reduced payment of HIV/AIDS

indicators is determined by the quality of general health services as measured by the score obtained using

the standardized national Quality Supervision tool. Financial incentives provided by PBF motivate health

facilities to improve performance through investments in training, equipment, personnel and payment

systems that better link individual pay to individual performance. As a result of successful pilots

implemented by CordAID, GTZ and BTC, the MOH has endorsed national scale-up of PBF for all health

services. The EP, in partnership with the World Bank, BTC and other donors, is supporting national

implementation of PBF for health services.

In FY 2007, MSH/PBF supported the GOR in collaboration with key donors to implement a national

strategy, policy, and model of PBF that applies to all health assistance and provided out-based financing to

health facilities in six districts through direct performance sub-contracts with health centers and district

hospitals for HIV/AIDS indicators. The EP adopted a strategy in FY 2007 to combine both input and output

financing to properly motivate health facilities for higher performance while providing necessary resources

and tools to meet the established targets. While PBF clearly increases performance, technical assistance

and basic input support is still needed, especially in the current context of rapid decentralization and

accelerated national roll-out of the PBF model by the GOR. At the health center level, EP partners purchase

a quantity of indicators with a performance incentive. Examples of indicators include correctly filling stock

control cards in X-ray departments, the percentage of TB lab exams that are corroborated during quarterly

controls, and the number of complete series of AFBs correctly done. Performance on these indicators are

measured during monthly control activities jointly conducted by the MSH/PBF district coordinator, clinical

partners, and the district's Family Health Unit and quality of services is evaluated through the existing

national supervisory and quality assurance mechanisms. The quantity and quality scores are merged during

the quarterly District PBF Steering Committee meetings and the final payments is approved. At the district

hospital level, MSH/PBF will have sub-contracts with slightly different purpose and scope from that of health

centers. In addition to the focus on increasing better quality service outputs, there is an emphasis on quality

assurance, self-evaluation, and review by peers similar to an accreditation scheme. There is payment for

indicators from the National District Hospital PBF Scheme which reinforces the supervisory role hospitals

play in district health networks.

In FY 2008, MSH/PBF will continue providing support to the MOH PBF department and the national PBF

TWG. In addition, MSH/PBF will provide TA to DHTs in all PEPFAR districts and to EP implementing

partners to effectively shift some of their input financing to output-based financing for HIV/AIDS indicators in

accordance with national policy. MSH/PBF will also provide intensive technical assistance to districts that

will be introducing PBF in FY2008. At the District level, MSH/PBF will continue supporting the national

model by 1) placing a district coordinator within the Family Health Unit to work with national family health

steering committee during data collection/entry and control of indicators, 2) facilitating the quantity control

function by providing TA and paying associated costs, and 3) supporting secretarial functions for the Family

Health Unit at the District level. Support to the District is critical for the proper functioning of the national

PBF model since monthly HIV/AIDS invoice approved by the health center PBF management committee

(COGE) and MSH are presented to the district steering committee for merging with quality index and final

approval before payments are made.

Performance-Based financing of HIV/AIDS services is a critical step to achieving the goal of sustainable,

well-managed, high quality, and cost-effective basic health care service delivery in a comprehensive

HIV/AIDS treatment network. This financing modality supports the Rwanda EP five-year strategy for

increasing institutional capacity for a district managed network model of HIV clinical treatment and care

services.

This activity is continuing from FY 2007. No new narrative is required.

This is a continuing activity from FY 2007. No narrative required.

Performance-based financing (PBF) is an innovative approach to health services financing based on

outputs, thereby enhancing quality of services and leading to greater efficiency and sustainability. Output

financing involves the purchase of indicators that are linked to performance incentives. These incentives are

linked to the quantity and quality of services provided by health facilities and hospitals. The payment scale

for HIV/AIDS indicators is commensurate with the scores obtained using the standardized national Quality

Supervision tool. PBF provides these financial incentives to motivate health facilities to improve

performance through investments in training, equipment, personnel and payment systems that better link

individual pay to individual performance. As a result of successful pilots implemented by CordAID, GTZ and

BTC, the MOH has endorsed national scale-up of PBF for all health services. The EP, in partnership with

the World Bank, BTC and other donors, is supporting national implementation of PBF of health services.

In FY 2007, MSH/PBF supported the GOR in collaboration with key donors to implement a national

strategy, policy, and model of PBF that applies to all health assistance. Consistent with the principles of

linking performance to incentives, MSH provided output-based financing to health facilities in six districts

through sub-contracts with health centers and district hospitals for HIV/AIDS indicators. The EP adopted a

strategy in FY 2007 to combine both input and output financing to properly motivate health facilities for

higher performance while providing necessary resources and tools to meet the established targets. In

Rwanda, though performance has increased with PBF, TA and basic input support is still needed, especially

in the current context of rapid decentralization and accelerated national PBF roll-out. At the health center

level, EP partners purchase a quantity of the 14 key HIV/AIDS indicators. Performance on these indicators

is measured during monthly control activities jointly conducted by the MSH/PBF district coordinator, clinical

partners, and the district's Family Health Unit. The quality of services is evaluated through the existing

national supervisory and quality assurance mechanisms. The quantity and quality scores are then merged

during the quarterly District PBF Steering Committee meetings and the final payments are approved.

MSH/PBF also has sub-contracts at the district hospital level for a slightly different purpose and scope than

with health centers. The focus of these contracts with district hospitals is on increasing quality service

outputs, quality assurance, self-evaluation, and review by peers similar to an accreditation scheme. There is

payment for indicators from the National District Hospital PBF Scheme, which reinforces the supervisory

role that hospitals play in district health networks.

In FY 2008, MSH/PBF will continue supporting the MOH PBF department and the national PBF TWG. In

addition, MSH/PBF will provide TA to DHTs and implementing partners in 23 EP districts to effectively shift

some of their input financing to output-based financing for HIV/AIDS indicators in accordance with national

policy. MSH/PBF will also provide intensive TA to districts that will introduce PBF in FY 2008. At the district

level, MSH/PBF will continue supporting the national model by 1) placing a district coordinator within the

Family Health Unit to work with the national family health steering committee during data collection/entry

and control of indicators; 2) facilitating the quantity control function by providing TA and paying associated

costs; and 3) supporting secretarial functions for the Family Health Unit at the district level. EP support to

the district is critical for the proper functioning of the national PBF model. Monthly invoices approved by the

health center PBF management committee (COGE) and MSH are then presented to the district steering

committee for merging with quality index and final approval before payments are made.

PBF of HIV/AIDS services is a critical step to achieving the goal of sustainable, well-managed, high quality,

and cost-effective basic health care service delivery in a comprehensive HIV/AIDS treatment network. This

financing modality supports the Rwanda EP five-year strategy by increasing institutional capacity for a

district managed network model of HIV clinical treatment and care services.

Technical assistance position previously anticipated to be funded through PHI.