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Are countries' policies working?
An evaluation of the performance of health centers in delivering HIV/AIDS services in Rwanda
Presented by Wu Zeng (United States).
A.K. Rwiyereka1, W. Zeng2, P. Amico1, D.S. Shepard2, C. Avila-Figueroa3
1Brandeis University, Heller School for Social Policy and Management, Waltham, United States, 2Brandeis University, Schneider Institutes for Health Policy, Waltham, United States, 3The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
Background: Performance
across countries in delivering HIV/AIDS services has been found to vary widely.
Similar variations might exist within a single country. We first
examined the overall efficiency of health centers in Rwanda in delivering three
key HIV/AIDS services?anti-retroviral therapy (ART), prevention of
mother-to-child transmission (PMTCT), and voluntary counseling and testing
(VCT). We then assessed the impact of
community-based health insurance (CBHI) schemes and performance-based financing
(PBF) in health on improving provision of these HIV/AIDS services.
Methods: Twenty-six
rural health centers in Rwanda
providing ART services by December 2006 were randomly selected. Data on each
center, compiled through site visits and central records, included numbers of
personnel, amounts of non-personnel expenditure on HIV/AIDS services, and volumes
of ART, VCT and PMTCT services in 2006 and 2007. We evaluated the performance
of each health center with data envelopment analysis (DEA). We estimated impacts of PBF and CBHI on AIDS
service provision using a fixed-effects model.
Results: As
implementation of PBF and CBHI grew from 2006 to 2007, the three AIDS services also
increased. The crude average efficiencies of health centers in delivering
HIV/AIDS services was 83.9% in 2006. The
production frontier shifted outward in 2007, with total efficiency increasing by
15.6% over 2006. Regression results
revealed that increased CBHI coverage contributed to the frontier shift,
improved efficiency, and greater outputs of PMTCT and VCT services; PBF showed a
significant impact on PMTCT services only.
Conclusions: Most
health centers in Rwanda
have been performing well. Corrective action might be useful for the 21% of
health centers with efficiency under 60% in both years. CBHI was a particularly important contributor
to improving utilization of HIV/AIDS services. The links from CBHI and PBF to HIV/AIDS
services demonstrate the beneficial effects of health system strengthening in
addressing HIV/AIDS.
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