Tapping Talent in Rwanda to Improve Healthcare
An interview with Paulin Basinga, lecturer at Rwanda School of Public Health
by IBER’s Casondra Sobieralski

A note from IBER Chair Paul Gertler: In early 2005, I was working with the Rwanda Government exploring the possibility of rigorously evaluating the impact of their new plan to pay medical care providers performance incentives. The plan’s aim was to improve the use and quality of maternal and child health care services and thereby improve maternal and child health outcomes. The Government invited a number of people from the community to join our discussions, including a quiet assistant professor from the National University of Rwanda, Paulin Basinga. During that meeting Paulin made a series of thoughtful comments that challenged perspectives of both the Government and the researchers. Thus we asked Paulin to join our evaluation team and created a UC Berkeley – National University of Rwanda collaboration. Paulin’s institutional knowledge, careful data analysis and insight have enriched our work and our lives. Our relationship is bi-directional, with us training and learning much from him. He has been visiting Berkeley intermittently this year, working with students and faculty. We thought that you might want to learn more about him.

CS: What is the scope of this project?

PB: Too many skilled healthcare providers were leaving Rwanda for richer countries. So the government of Rwanda received a grant from World Bank to institute a program which will increase health care provider motivation and increase the quality and quantity of care they are providing to the population. The government selected key objectives related to UN Millennium Development Goals. The government evaluates the health care program based on the quality of those indicators. Care is taken not to prioritize quantity over quality.

CS: What are examples of indicators that the World Bank uses to judge progress towards Millennium Goals?

PB: As recommended by the World Health Organization, we look at the number of women coming in for prenatal care, contraception, and medically assisted deliveries. We measure the number of child vaccinations, tetanus vaccines, and consultation cases. We also look at the number of children who are monitored for nutritional problems and the number of pregnant women who are referred to higher levels of care.

CS: How does this approach differ from past approaches?

PB: Before, quantity was considered more than quality. With the new project, implementation is done at the same time as impact evaluation design. Some districts were selected to be part of the intervention, and some were selected to be control groups. Both the intervention groups and the control groups receive financial incentives, but pay for the intervention groups is based on performance, while the control groups receive an average of what the intervention groups are receiving. This method sets a good measure for income effect. What is new in this project is that we are really evaluating the capacity of this particular intervention program to generate behavior change among providers.

CS: What is your specific role, and who else is involved?

PB: I was the survey director in Rwanda. I did implementation design and follow up. Now I am working with a team here for data analysis for one component of our work, general health. The other component is HIV prevention. In terms of the institutions, UC Berkeley, the World Bank, the Rwandan government, the Rwanda School of PublicHealth, and the National Institute of Public Health in Mexico are all involved. People involved here at UCB include Professor Paul Gertler, Ricardo Cavazos, Rosangela Bando, and Jennifer Sturdy, who is also with World Bank.

CS: Are there any outcomes to report?

PB: We are seeing interesting results. We are certainly seeing that the program has increased the quality of pre-natal care services. We have good predictions on other indicators that we are now analyzing. This project was really an opportunity for the Rwanda School of Public Health. By collaborating with the UC Berkeley, we learned more about techniques. Rather than just collecting data, we were learning from Prof. Gertler how to work with and analyze that data. In the future, I will be better prepared to do a project like this myself.

CS: How might the approaches used in Rwanda influence the way other countries manage health care?

PB: I think this is the first rigorous evaluation of a pay for performance program. Other programs have not controlled for as many factors. This experience in Rwanda will help other countries see how to keep more providers in their home countries and how to keep those providers motivated to give quality care.

For more information, please see:
http://www.pbfrwanda.org.rw
http://www.nursph.org