Original Research

Contribution analysis as an evaluation strategy in the context of a sector-wide approach: Performance-based health financing in Rwanda

Martin Noltze, Felix Gaisbauer, Thomas Schwedersky, Stefanie Krapp
African Evaluation Journal | Vol 2, No 1 | a81 | DOI: https://doi.org/10.4102/aej.v2i1.81 | © 2014 Martin Noltze, Felix Gaisbauer, Thomas Schwedersky, Stefanie Krapp | This work is licensed under CC Attribution 4.0
Submitted: 30 April 2014 | Published: 18 December 2014

About the author(s)

Martin Noltze, German Institute for Development Evaluation (DEval), Germany
Felix Gaisbauer, German Institute for Development Evaluation (DEval), Germany
Thomas Schwedersky, German Institute for Development Evaluation (DEval), Germany
Stefanie Krapp, German Institute for Development Evaluation (DEval), Germany


Share this article

Bookmark and Share

Abstract

Sector-wide approaches (SWAps) emerged as a response to donor fragmentation and non-adjusted and parallel programming. In the health sector, SWAps have received considerable support by the international donor community due to their potential to reduce inefficiencies through alignment to common procedures and hence to increase development effectiveness. Evaluating development cooperation in the context of a SWAp, however, translates into methodological challenges for evaluators who have to disentangle the cumulative effects in strongly donor-aligned, complex sector environments. In this article the authors discussed the application of a methodological strategy for evaluating development interventions in complex settings – for example in the context of a SWAp –and reflected the suitability of the approach. The authors conducted a contribution analysis, a theory-based approach to evaluation, and exemplified the approach for an intervention of performance-based financing for Rwandan health workers supported by the Rwanda-German cooperation. The findings suggested that the Rwandan system of performance based financing increased service orientation and outputs of health professionals, but also indicated that negative motivational side effects and resource constraints are real. With regard to the methodological approach, the authors conclude that contribution analysis has a high potential to evaluate development cooperation in the context of a SWAp dueto its high flexibility to use different data collection tools and its capability to assess risks and rival explanations. Challenges can be identified with regard to the efficiency of the evaluation strategy and a remaining trade-off between scope and causal strength ofevidence.


Keywords

Sector-wide Approach; Health; Contribution Analysis; Rwanda

Metrics

Total abstract views: 4357
Total article views: 7090


Crossref Citations

No related citations found.