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Impact
evaluation of performance based contracting (PBC) for HIV/AIDS treatment in Rwanda
S. Bautista-Arredondo1, S. Bertozzi1,2, A. Binagwaho3, J.D.D. Bizimana4, J. Condo4, D. de Walque5, P. Gertler2, A. Kwan1, K. Machusick1, J. Sturdy5
1Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico, 2University of California at Berkeley, Berkeley, United States, 3Rwanda Ministry of Health, Kigali, Rwanda, 4National University of Rwanda School of Public Health, Kigali, Rwanda, 5World Bank, Washington, United States
Background: Shortage of
health staff in developing countries adversely affects the lives of millions.
This study will provide rigorous empirical evidence on whether PBC for HIV/AIDS
treatment is an effective method for improving health outcomes of HIV/AIDS
patients in Rwanda.
PBC involves
transferring conditional funds to health care centers. Payments includes a
fixed budget independent of performance, and a payment whose size depends on a
set of performance indicators such as VCT, PMTCT and ART delivery. Funds from
the PBC can be used for any purpose, including topping up staff salaries, at
the discretion of the facility.
Methods: An
impact evaluation was conducted, taking advantage of a prospective
quasi-experimental design. The sample consists of 36 facilities (1500 HIV+
patients plus 500 households of unknown HIV status in the same communities).
Half the sample received PBC in 2006 (treatment group), and half in 2008
(control group). Treatment facilities receive extra resources through the PBC
and control facilities receive extra resources of an equal amount not linked to
performance. Pre-intervention and post-intervention follow-up data was
collected in treatment and control areas to measure facility performance
indicators and individual outcomes.
Results: We
are currently conducting analysis of the data and will have results this
summer. Analysis of the PBC program in Rwanda has already shown a positive
effect on quantity and quality of maternal and child health services. Results
found on HIV/AIDS treatment and care will be relevant and interesting
independently of their magnitude and direction. Given that this is likely the
first rigorous evaluation of a PBC intervention for HIV/AIDS services in Africa, it is key to share these results promptly and widely.
Conclusions: PBC
might prove an important tool to address the human resources crisis while at
the same time providing incentives to improve access to quality of treatment
and care.
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