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Improving health worker performance: The patient-perspective from a PBF program in Rwanda

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  • Lannes, Laurence

Abstract

The effect of performance-based financing (PBF) on patients' perception of primary health care services in developing countries in not well documented. Data from a randomized impact evaluation in Rwanda conducted between 2006 and 2008 in 157 primary level facilities is used to explore patients' satisfaction with clinical and non-clinical services and quantify the contribution of individual and facility characteristics to satisfaction including PBF. Improvements in productivity, availability and competences of the health workforce following the implementation of PBF have a positive effect on patients' satisfaction with clinical services even if patients' satisfaction is not tied to a reward. The positive effect of PBF on non-clinical dimensions of satisfaction also suggests that PBF incentivizes providers to raise patients' satisfaction with non-clinical services if it is associated with future financial gains. It is recommended that low and middle income countries build on the experience from high income countries to better listen to patients' voice in general and include an assessment of patients' satisfaction in incentive mechanisms as a way to increase the benefits of the strategy.

Suggested Citation

  • Lannes, Laurence, 2015. "Improving health worker performance: The patient-perspective from a PBF program in Rwanda," Social Science & Medicine, Elsevier, vol. 138(C), pages 1-11.
    • Handle: RePEc:eee:socmed:v:138:y:2015:i:c:p:1-11
    DOI: 10.1016/j.socscimed.2015.05.033
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    References listed on IDEAS

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    1. Lohmann, Julia & Koulidiati, Jean-Louis & Robyn, Paul Jacob & Somé, Paul-André & De Allegri, Manuela, 2022. "Why did performance-based financing in Burkina Faso fail to achieve the intended equity effects? A process tracing study," Social Science & Medicine, Elsevier, vol. 305(C).
    2. Dimitri Renmans & Nathalie Holvoet & Bart Criel, 2017. "Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda," IJERPH, MDPI, vol. 14(9), pages 1-20, September.
    3. Elisabeth Paul & Oriane Bodson & Valéry Ridde, 2021. "What theories underpin performance-based financing? A scoping review," ULB Institutional Repository 2013/318091, ULB -- Universite Libre de Bruxelles.
    4. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).

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