Signed, Sealed, Delivered? Evidence from Rwanda on the Impact of Results-based Financing for Health

Lindsay Morgan
The World Bank Group


Excitement is growing about results-based financing (RBF) for health, a financing mechanism that turns the traditional donor approach of paying for inputs on its head. RBF for health is a cash payment or non-monetary transfer made to a national or sub-national government, provider, payer, or consumer of health services after predefined results have been attained and verified. Payment is conditional on measureable actions being taken.[1] Where RBF has been tried, experience suggests it can improve health outcomes and strengthen health systems. But there is little rigorous evidence on its impact and many questions remain: Does focusing on some health interventions lead to the neglect of others? Will the approach encourage people to cheat to receive the incentive? Is it cost-effective? Will it diminish workers’ intrinsic motivation? What about unintended consequences?

On May 8, 2009, the results of one of the first rigorous, scientific evaluations of RBF in one country were unveiled in the Rwandan capital of Kigali. Rwanda began paying for performance at the health facility level in 2006, in an effort to improve maternal and child health. The evaluation shows that the program had a significant impact on the use and quality of maternal and child health services, with initial results indicating improvements in child health outcomes. The global health community now has strong evidence from one country that RBF can work. So how did it all begin?

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  • MLI Voices

    Jun 22 2009 - 4:25pm

    Sierra Leone

    Even though I have worked in Sierra Leone in the past, the role of MLI Country Lead has given me the opportunity to build upon these previous experiences and to work closely with members of the Ministry of Health and Sanitation (MOHS), to support the implementation of health policies and reforms that they have prioritized.


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