Biomaterial Database

'Paying for performance' in Rwanda: does it pay off? 2010

Andreas Kalk, and Friederike Amani Paul, and Eva Grabosch

Health Section, Gesellschaft für Technische Zusammenarbeit, Eschborn, Germany. andreas.kalk@gtz.de

The study analyses strengths and weaknesses of the 'Paying For Performance' (P4P) approach rolled out in the Rwandan health sector since 2002. It uses three research methods: a cross-sectoral literature review on P4P, its history and its context; 69 mostly semi-structured interviews conducted in Rwanda; and an analysis of factors eventually confounding the impact evaluation of the Rwandan P4P approach. It is argued that P4P approaches can be traced backed in written form over four millennia and that considerable negative effects are reported throughout history. All side effects were found again in various forms in the Rwandan health sector. One particular side effect -'gaming'- seriously threatens to affect the quality of health services. It is argued that P4P implicitly (and unintentionally) promotes a questionable concept of human 'labour' and that its focus on improving indicators rather than systemic changes can be regarded as vertical and counter-productive. Two alternatives to the current P4P system are briefly depicted, and further research on the described challenges is recommended.

UI	MeSH Term	Description	Entries
D007407	Interviews as Topic	Works about conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes works about school admission or job interviews.	Group Interviews,Interviewers,Interviews, Telephone,Oral History as Topic,Group Interview,Interview, Group,Interview, Telephone,Interviewer,Interviews, Group,Telephone Interview,Telephone Interviews
D011785	Quality Assurance, Health Care	Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.	Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D003906	Developing Countries	Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.	LMICs,Less-Developed Countries,Low Income Countries,Low and Middle Income Countries,Lower-Middle-Income Country,Middle Income Countries,Third-World Countries,Under-Developed Countries,Developing Nations,Least Developed Countries,Less-Developed Nations,Third-World Nations,Under-Developed Nations,Countries, Middle Income,Countries, Third-World,Country, Least Developed,Country, Less-Developed,Country, Low Income,Country, Lower-Middle-Income,Country, Middle Income,Country, Third-World,Country, Under-Developed,Developed Country, Least,Developing Country,Developing Nation,Least Developed Country,Less Developed Countries,Less Developed Nations,Less-Developed Country,Less-Developed Nation,Low Income Country,Lower Middle Income Country,Lower-Middle-Income Countries,Middle Income Country,Nation, Less-Developed,Nation, Third-World,Nation, Under-Developed,Third World Countries,Third World Nations,Third-World Country,Third-World Nation,Under Developed Countries,Under Developed Nations,Under-Developed Country,Under-Developed Nation
D004649	Employee Incentive Plans	Programs designed by management to motivate employees to work more efficiently with increased productivity, and greater employee satisfaction.	Incentive Plans, Employee,Employee Incentive Plan,Incentive Plan, Employee,Plan, Employee Incentive,Plans, Employee Incentive
D004650	Employee Performance Appraisal	The assessment of the functioning of an employee in relation to work.	Nurses Performance Evaluation,Performance Appraisal, Employee,Family Planning Personnel Evaluation,Appraisal, Employee Performance,Appraisals, Employee Performance,Employee Performance Appraisals,Evaluation, Nurses Performance,Evaluations, Nurses Performance,Nurses Performance Evaluations,Performance Appraisals, Employee,Performance Evaluation, Nurses,Performance Evaluations, Nurses
D006282	Health Personnel	Men and women working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. (From A Discursive Dictionary of Health Care, 1976)	Health Care Professionals,Health Care Providers,Healthcare Providers,Healthcare Workers,Health Care Professional,Health Care Provider,Healthcare Provider,Healthcare Worker,Personnel, Health,Professional, Health Care,Provider, Health Care,Provider, Healthcare
D006302	Health Services Research	The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)	Health Care Research,Medical Care Research,Research, Health Services,Action Research,Health Services Evaluation,Healthcare Research,Research, Medical Care,Evaluation, Health Services,Evaluations, Health Services,Health Services Evaluations,Research, Action,Research, Health Care,Research, Healthcare
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012432	Rwanda	A republic in eastern Africa, south of UGANDA, east of DEMOCRATIC REPUBLIC OF THE CONGO, west of TANZANIA. Its capital is Kigali. It was formerly part of the Belgian trust territory of Ruanda-Urund.	Ruanda,Republic of Rwanda
D015986	Confounding Factors, Epidemiologic	Factors that can cause or prevent the outcome of interest but are not intermediate variables of the factor(s) under investigation.	Confounding Factor, Epidemiologic,Confounding Factors, Epidemiological,Confounding Factors, Epidemiology,Confounding Variables,Confounding Variables, Epidemiologic,Confounding Variables, Epidemiological,Confounding Factor, Epidemiological,Confounding Factor, Epidemiology,Confounding Variable,Confounding Variable, Epidemiologic,Confounding Variable, Epidemiological,Epidemiologic Confounding Factor,Epidemiologic Confounding Factors,Epidemiologic Confounding Variable,Epidemiologic Confounding Variables,Epidemiological Confounding Factor,Epidemiological Confounding Factors,Epidemiological Confounding Variable,Epidemiological Confounding Variables,Epidemiology Confounding Factor,Epidemiology Confounding Factors,Variable, Confounding,Variable, Epidemiologic Confounding,Variable, Epidemiological Confounding,Variables, Confounding,Variables, Epidemiologic Confounding,Variables, Epidemiological Confounding