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Reviewing institutions of rural health centres: The performance initiative in Butare, Rwanda

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Meessen, Bruno Musango, Laurent Kashala, Jean-Pierre I. Lemlin, Jackie

In many low-income countries, performance of pyramidal health systems with a public purpose is not meeting the expectations and needs of the populations they serve. A question that has not been studied and tested sufficiently is, 'What is the right package of institutional mechanisms required for organisations and individuals working in these health systems?' This paper presents the experience of the Performance Initiative, an innovative contractual approach that has reshaped the incentive structure in place in two rural districts of Rwanda. It describes the general background, the initial analysis, the institutional arrangement and the results after 3 years of operations. At this stage of the experience, it shows that 'output-based payment + greater autonomy' is a feasible and effective strategy for improving the performance of public health centres. As part of a more global package of strategies, contracting-in approaches could be an interesting option for governments, donors and non-governmental organisations in their effort to achieve some of the Millennium Development Goals.

Document type Article de périodique (Journal article) – Article de recherche
Publication date 2006
Language Anglais
Journal information "Tropical Medicine & International Health" - Vol. 11, no. 8, p. 1303-1317 (2006)
Peer reviewed yes
Publisher Blackwell Publishing (Oxford)
issn 1360-2276
e-issn 1365-3156
Publication status Publié
Affiliation UCL
Keywords contracting ; fee-for-service ; health services ; developing countries ; millennium development goals
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Bibliographic reference Meessen, Bruno ; Musango, Laurent ; Kashala, Jean-Pierre I. ; Lemlin, Jackie. Reviewing institutions of rural health centres: The performance initiative in Butare, Rwanda. In: Tropical Medicine & International Health, Vol. 11, no. 8, p. 1303-1317 (2006)
Permanent URL http://hdl.handle.net/2078.1/38333