Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 170
Country/Region: Rwanda
Year: 2009
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $0

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $0

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

New/Continuing Activity: Continuing Activity

Continuing Activity: 12854

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12854 2814.08 U.S. Agency for Management 6315 170.08 HIV/AIDS $298,972

International Sciences for Performance

Development Health Based Financing

7219 2814.07 U.S. Agency for Management 4339 170.07 HIV/AIDS $746,240

International Sciences for Performance

Development Health Based Financing

2814 2814.06 U.S. Agency for Management 2577 170.06 HIV/AIDS $600,000

International Sciences for Performance

Development Health Based Financing

Table 3.3.01:

Funding for Care: TB/HIV (HVTB): $0

New/Continuing Activity: Continuing Activity

Continuing Activity: 12856

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12856 4001.08 U.S. Agency for Management 6315 170.08 HIV/AIDS $179,383

International Sciences for Performance

Development Health Based Financing

7221 4001.07 U.S. Agency for Management 4339 170.07 HIV/AIDS $746,240

International Sciences for Performance

Development Health Based Financing

4001 4001.06 U.S. Agency for Management 2577 170.06 HIV/AIDS $144,000

International Sciences for Performance

Development Health Based Financing

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $0

This is a continuing activity from FY 2008. No narrative required.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12857

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12857 2812.08 U.S. Agency for Management 6315 170.08 HIV/AIDS $298,971

International Sciences for Performance

Development Health Based Financing

7217 2812.07 U.S. Agency for Management 4339 170.07 HIV/AIDS $373,120

International Sciences for Performance

Development Health Based Financing

2812 2812.06 U.S. Agency for Management 2577 170.06 HIV/AIDS $400,000

International Sciences for Performance

Development Health Based Financing

Table 3.3.14:

Funding for Strategic Information (HVSI): $0

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.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12859

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

12859 8743.08 U.S. Agency for Management 6315 170.08 HIV/AIDS $298,972

International Sciences for Performance

Development Health Based Financing

8743 8743.07 U.S. Agency for Management 4339 170.07 HIV/AIDS $559,680

International Sciences for Performance

Development Health Based Financing

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $0

Technical assistance position previously anticipated to be funded through PHI.

New/Continuing Activity: Continuing Activity

Continuing Activity: 19482

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

19482 19482.08 U.S. Agency for Management 6315 170.08 HIV/AIDS $300,000

International Sciences for Performance

Development Health Based Financing

Table 3.3.18: