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Am J Trop Med Hyg. 2014 Apr;90(4):740-6. doi: 10.4269/ajtmh.12-0697. Epub 2014 Feb 10.

Efficiency of HIV/AIDS health centers and effect of community-based health insurance and performance-based financing on HIV/AIDS service delivery in Rwanda.

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Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts; Futures Group International, Washington, District of Columbia; Global Health Issues and Solutions, Kigali, Rwanda; RTI International, Waltham, Massachusetts; Abt Associates, Bethesda, Maryland.


This study evaluates the efficiency of rural health centers in Rwanda in delivering the three key human immunodeficiency virus/acquired immunodeficiency syndrome services: antiretroviral treatment, prevention of mother-to-child transmission, and voluntary counseling and testing using data envelopment analysis, and assesses the impact of community-based health insurance (CBHI) and performance-based financing on improving the delivery of the three services. Results show that health centers average efficiency of 78%, and despite the observed variation, the performance increased by 15.6% from 2006 through 2007. When the services are examined separately, each 1% growth of CBHI use was associated with 3.7% more prevention of mother-to-child transmission and 2.5% more voluntary counseling and testing services. Although more health centers would have been needed to evaluate performance-based financing, we found that high use of CBHI in Rwanda was an important contributor to improving human immunodeficiency virus/acquired immunodeficiency syndrome services in rural health centers in Rwanda.

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