Performance-based financing to improve supply chain practices and increase medicine availability at the community level: Lessons from Rwanda

In Rwanda, volunteer community health workers (CHWs) provide treatment for pneumonia, diarrhea, and malaria to children under five in their villages. The SC4CCM 2010 baseline assessment of the community supply chain identified two barriers to commodity availability: limited logistics knowledge and skills among CHWs and other staff at resupply points, and low CHW motivation to carry out supply chain tasks.

To address these barriers, SC4CCM tested a community-based supply chain incentives approach for one year, building on Rwanda's existing performance-based financing (PBF) system. The intervention aimed to motivate CHWs by providing an incentive package rewarding regular attention to and proper performance of routine supply chain tasks. The intervention was designed to improve performance in priority supply chain areas by providing quarterly monetary incentives to CHW cooperatives in three districts. Incentives were awarded based on monthly achievements on 10 indicators, including stock management, record keeping, and reporting.

The project will evaluate the intervention in the second quarter of 2013 using a difference-in-difference analysis model with a mixed-methods approach. Quantitative midline data will be collected from intervention and control groups to compare changes over time and determine impact on community-level product availability and key supply chain indicators. Qualitative data from focus group discussions will be used to triangulate quantitative results and broaden the understanding of the intervention's impact. The presentation will describe how these findings inform the recommended design of a national supply chain incentives scheme and program scale-up plan in Rwanda, as well as potential applications for other settings.