East Africa - Public health laboratory networking project: evaluation of performance-based financing for public health laboratories in Rwanda

Meghan Kumar, Joel Thomas Lehmann, Aniceth Rucogoza, Claver Kayobotsi, Ashis Kumar Das and Miriam Schneidman

No 105015, Health, Nutrition and Population (HNP) Discussion Paper Series from The World Bank

Abstract: This report summarizes the main findings from the application of performance based incentives linked to progress on a standardized, globally recognized metric - the stepwise laboratory improvement process towards accreditation (SLIPTA) checklist - under the East Africa Public Health Laboratory Networking Project (EAPHLNP) in Rwanda. ... See More + The lab performance-based financing (PBF) pilot was introduced in the context of a well-established national PBF program dating back to the early 2000s. The flexible nature of the EAPHLNP and the favorable context in Rwanda provided an ideal backdrop to introduce PBF incentive payments to accelerate progress of five project supported labs towards accreditation. The evaluation found improved laboratory performance at all project-supported laboratories in Rwanda as measured by the SLIPTA scores. For the first time, laboratories were bringing in PBF revenues, instilling a culture of continuous quality improvements, and focusing management attention on accreditation. PBF appears to have contributed to an accelerated change, with PBF laboratories experiencing an overall greater increase in SLIPTA scores compared to project-supported laboratories in the other countries. No clear patterns were found in terms of improved test volumes or test accuracy, which were not part of the pilot scheme. While it was difficult to disentangle the effects of different interventions, the evaluation found a system-strengthening value to combining investments in modernizing laboratories, and strengthening human resources with PBF. Relationships between laboratory staff and clinicians improved, with laboratory managers having a greater voice in hospital management and lab staff increasingly valued and respected by clinicians. A spirit of teamwork prevailed at participating sites. Other countries considering PBF mechanisms for public health laboratories need to take into account lessons learned and assess the features which may be relevant to their own contexts. PBF schemes for laboratories need to be viewed as an integral part of a package of interventions that contribute to enhanced performance.

Keywords: waste; risks; quantitative research; rights; supervision; equipment; customer; communication technologies; knowledge sharing; time; prevention; morbidity; community health ... See More + data collection; information; monitoring; health care; effects; health; capacity building; verification; planning; research design; management systems; pilot project; turnaround times; measures; public health; qualitative data; enabling environment; satellite; hospitalization; experimental design; cells; hardware; knowledge; immune system; institutions; data; exercises; scenarios; laboratory equipment; patient; patients; tests; performance indicators; intervention; laboratory technicians; laboratories; targets; trigger; nurses; laboratory infrastructure; documents; laboratory accreditation; sciences; consultant; web; standardization; field work; indicators; research; customer service; material; standards; data analysis; work environment; testing services; interview; inventory; improvement; mortality; testing; grants; capabilities; specimens; infrastructure; methods; technology; transaction; interviews; travel; safety officer; workers; procurement; quality management; payout; patient satisfaction; best practices; results; surveillance; validity; age; health authorities; health policy; raw data; quantitative data; health outcomes; management system; stress; samples; size; measurement; fund management; labs; nutrition; confidentiality; surveys; web portal; primary health care; citizens; internet; regression analysis; result; weight; physicians; ict; creative solutions; theory; technical staff; lab; network; evaluation; human resources; sampling; isolation; performance; research findings; innovation; performance indicator; certificates; sites; protocol; financial support; institutionalization; research methods; communication; statistical analysis; strategy; laboratory; institutional framework; child health services; methodology; hospitals; communications technology; technologies; financial constraints; implementation; health services; uses; quality of service; innovations; informants; missing data; service providers (search for similar items in EconPapers)
Pages: pages 74 pages
Date: 2016-04
New Economics Papers: this item is included in nep-hea
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