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Quest to Reduce Donor Dependence in Community Health Financing

Ivan Ngoboka

The government has turned to local solutions as a way of reducing reliance on foreign aid in the facilitation of community-based health workers. This was said on Friday during an impact assessment workshop of the community-based health workers (CBHWs), who are currently facilitated through a World Bank project dubbed, ‘Performance-Based Financing’ (PBF).

“In the future, we expect aid funding to reduce, so we shall need alternative income sources,” said Cathy Mugeni, the director of community health unit at the Ministry of Health. PBF is defined as a mechanism by which health caregivers are, at least partially, funded on the basis of their performance.

According to Mugeni 50 per cent of PBF money dedicated for community based health work programmes is saved to cater for sustenance of future projects, while 20 per cent is paid to individual CBHWs, and 30 per cent to CBHW’s co-operatives. Rwanda currently has 45,000 CBHW’s grouped in 468 co-operatives, each village has a minimum of two, they are in charge of monitoring pregnant mothers, fighting malnutrition, co-ordination of vaccination programmes, among other things.

They use a phone application system called ‘Rapid SMS’ to report the cases to health centres and the ministry. Emery Hezagiza, the in-charge of PBF at the Ministry of Health, said starting from January, payment has been done depending on individual and not co-operative performance as was the case before.

This aims to reduce cases of individual complacence. “Payment now will be based on the number of reports filed by individuals through rapid SMS,” he said.

Over the years, there have been isolated cases of embezzlement of funds by individuals who run the co-operatives, Hezagiza said, adding that such cases have reduced in the last two years since a competitive private auditing and management firm took over supervision.

Assupta Mukangarambe, a CBHW in Kabarore Sector, Nyagatare District, welcomed the idea of payment based on individual performance, saying it would encourage participants to put in maximum effort.

Published: March 16, 2015. By Ivan Ngoboka
© Copyright The New Times Rwanda 2007 – 2015

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