Rwanda PBF module for DHIS-2

Background

• Rwanda’s 45,000 Community Health Workers (CHWs) are not paid

but form about 500 CHW cooperatives that receive performance-based payments that are invested in income generating projects and share the revenues with members

Chronology

• 2010: Data entered in OpenPBF module as part of integrated Community HMIS/PBF system

• 2012: System moved to DHIS-2 for data entry as part of Rwanda’s sustainability policy – most analysis still done off-line (Excel) because of need for external tables to support bank accounts, indicator tariffs, quality assessments/scores. Data imported from clinical PBF (php/MySQL platform)

• 2014: Developed PBF module to provide UI to manage PBF configuration and move calculated data into the datavalue table so that it can be analyzed using existing DHIS-2 tools

Rwanda Quarterly PBF payment calculation Indicators: Quantity Tariff Amount Facility deliveries 360 650 234,000 ANC registrations during 1st trimester 400 500 200,000 Children assessed for nutrition status (MUAC) 8,500 50 200,000

634,000 Multiplied by: Quarterly PBF Quality Assessment score 85% PBF Payment amount 538,900 Plus: Steering committee payment 100,000 Report amount (Adjusted by % population) 3 105,000 315,000 Total payment amount 953,900

Pay into PBF bank account Bank of Kigali BK Musanze 089887765

Tariffs

Bank details

Paid data elements

Quality Assessment

Health Sector Population

Tariff and Target setting

• Set tariffs for indicators at pre-determined levels for specific periods

Manage bank accounts

• Associate Bank accounts with the different PBF payment schemes

Set Quality Max Scores

Enter Quality Assessment Score

Enter PBF indicator data

Adjust tariffs according to funds available

Data Visualization & Sharing • Use built-in Dashboard and data visualization tools

• Use Web API to embed objects in other web sites

New ideas:

• Mobile payment of Community PBF incentives

• Payments made directly to community health workers rather than through the cooperative

• Import of PBF indicators from other systems –

• RapidSMS – CHWs paid based upon the number of visits reported per pregnant woman recorded

• RHMIS – Health center data on FP users imported from HMIS instance of DHIS-2

• LimeSurvey – aggregate quality scores imported into DHIS-2

Challenges

• PBF funding availability is often variable – difficult to maintain fixed tariffs

• Different PBF schemes require complex combinations of parameters to calculate payments including: • Indicator tariffs

• Catchment area population

• Quality assessment scores

• Report payment

• Steering committee payment

• Partner contributions (indicators and health facilites)

• Rwanda Community PBF complicated by Impact evaluation study during first 2 years (4 different payment groups)

• How to keep pace with DHIS-2 development – new versions every 2 months?