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

Tropical Medicine & International Health : TM & IH
Andreas KalkEva Grabosch

Abstract

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.

References

May 7, 2002·Social Science & Medicine·Lynne Miller FrancoRuth Kanfer
Aug 23, 2005·Lancet·Benjamin Loevinsohn, April Harding
Sep 2, 2005·Tropical Medicine & International Health : TM & IH·Andreas KalkGerard Foulon
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Jun 6, 2009·Tropical Medicine & International Health : TM & IH·Louis RusaWerner Vandenbulcke

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Citations

Nov 2, 2011·Health Policy and Planning·Valéry RiddeGhislaine Conombo
Jun 14, 2013·Health Policy and Planning·Nathalie Holvoet, Liesbeth Inberg
Oct 8, 2013·BMC Health Services Research·Ngozi AkwataghibeMarjolein Dieleman
Oct 11, 2011·Human Resources for Health·Sophie WitterAbdul Bari
Sep 8, 2011·Bulletin of the World Health Organization·Paulin BasingaJeanine Condo
Apr 10, 2014·Human Resources for Health·James S MillerGerald A Paccione
Sep 18, 2014·BMC Health Services Research·Anna Elisabet OlafsdottirJosephine Borghi
May 11, 2011·Bulletin of the World Health Organization·Andreas Kalk
Aug 28, 2012·Social Science & Medicine·Priscilla Magrath, Mark Nichter
Mar 19, 2016·Health Promotion International·Akihito WatabeMotoyuki Yuasa
Sep 8, 2011·Bulletin of the World Health Organization·Megan IrelandBruno Dujardin
Sep 4, 2015·Globalization and Health·Victor ChimhutuKaren Marie Moland
Sep 24, 2013·BMC Health Services Research·Robert K BasazaIvana Chapčáková
Mar 19, 2015·Journal of Health Services Research & Policy·Aidin AryankhesalSaeade Mahdipour
Apr 7, 2017·The International Journal of Health Planning and Management·Elisabeth Paul, Dimitri Renmans
Jan 13, 2018·International Journal of Health Policy and Management·Elisabeth PaulKarel Gyselinck
Oct 5, 2015·Social Psychiatry and Psychiatric Epidemiology·Aline UmubyeyiGunilla Krantz
Aug 19, 2014·The International Journal of Health Planning and Management·Hyacinthe Tchewonpi KankeuMohammad Abu-Zaineh
Aug 17, 2018·The International Journal of Health Planning and Management·Zawora Rita ZizienVincent De Brouwere
Aug 1, 2018·BMJ Quality & Safety·Suhas GondiAshish Jha

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