PBF: Plumbing Based Financing?

On January 27, 2012, in aid effectiveness, health financing, Rwanada, by Karen Grepin

One of the most remarkable parts of being engaged on Twitter is the types of global health “celebrities” who have begun to engage actively on this network. Whether it be Richard Horton, the editor of the Lancet asking readers for input, Rob Yates, Senior Health Economist at the WHO extolling the virtues of free health care services, or Martin McKee linking to his weekly publications in top ranked journals, there is never a dull moment for me.

But perhaps one of the most interesting personalities to have begun to engage actively via Twitter is Agnes Binagwaho, the Minister of Health of Rwanda, who in addition to tweeting actively runs a regular #MinisterMonday discussions where she asks Tweeps to submit questions in real time and she responds to them publicly via Twitter.

This morning she used Twitter in another way: she announced that the Ministry of Health has issued a 3-month ultimatum to all hospitals in Rwanda to build sufficient toilets in their facilities or risk losing the additional financing that has come online in Rwanda through what is known as the “Performance Based Financing (PBF)” scheme. I love it: it is bold, it is unconventional, and it might even work. Toilets are not sexy but I can tell you as a pregnant woman myself, they are completely indispensable in my life and the thought of spending anytime at a facility – even a hospital – without one is unthinkable (and we wonder why women don’t like delivering in public hospitals?).

In my view, Rwanda has become a bit of an outlier in recent years in health system improvement efforts, largely due to this unconventional approach to implementing programs and their willingness to try new things. Perhaps this initiative might even catch on elsewhere?

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17 Responses to “PBF: Plumbing Based Financing?”

  1. Karen Grepin says:

    PBF: Plumbing Based Financing? http://t.co/ULrIV7XN (Inspired by @agnesbinagwaho) #globalhealth

  2. RT @KarenGrepin: PBF: Plumbing Based Financing? http://t.co/RI3J14QH

  3. PBF: Plumbing Based Financing? http://t.co/ULrIV7XN (Inspired by @agnesbinagwaho) #globalhealth

  4. Smile- & thought-provoking blog by @KarenGrepin re: boss' newest policy in #Rwanda: "PBF, Plumbing-Based Financing?" http://t.co/BXNqypt3

  5. PBF – that's plumbing-based-financing in Rwanda RT @KarenGrepin http://t.co/cCx3gJWv

  6. alicesabi says:

    #PBF: Plumbing Based Financing? http://t.co/E094DzEd #globalhealth #healthfinancing #sanitation

  7. Bruno Meessen says:

    PBF is indeed offering new opportunities for resolute leaders. If you want to read more on PBF, check regularly the following two blogs:



    Both are mixing posts in English and French.

  8. PBF: Plumbing Based Financing? http://t.co/ULrIV7XN (Inspired by @agnesbinagwaho) #globalhealth

  9. PBF: Plumbing Based Financing? http://t.co/ULrIV7XN (Inspired by @agnesbinagwaho) #globalhealth

  10. Louis RUSA says:

    It is important that change might be continuous and i don*t doubt enymore that PBF will continue to help bring the needed change. Good Hygiene is one of the most strategy to reduce the burden of diseases and I do agree with the minister on that subject.

  11. Ann Allen says:

    RT @KarenGrepin: PBF: Plumbing Based Financing? http://t.co/GpLAluMg

  12. PBF: Plumbing Based Financing? via @karengrepin & @agnesbinagwaho http://t.co/kMzBh7D2

  13. […] Any time I see an initiative for building a large number of new latrines or toilets (like this), I worry about that all-important maintenance component that turns the toilets into a permanent […]

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