Effects of community performance-based financing on community health workers’ service delivery in Kayanza health district, Burundi


  • Manirakiza Gervais Department of Epidemiology and Biostatistics, School of Public Health, Mount Kenya University, Kenya
  • Alfred Owino Odongo Department of Epidemiology and Biostatistics, School of Public Health, Mount Kenya University, Kenya
  • Apollo Maima School of Pharmacy, Maseno University, Kenya




Community health workers, Community health worker’s Cooperative, Community performance-based financing


Background: In many low- and middle-income countries, community services are often provided on a volunteer basis. To make their work more effective in the communities, some of them including Burundi adopted community performance-based financing as form of motivation of community health workers (CHWs). The study aimed to demonstrate the relationship between the community performance-based financing and health service delivery by the community health workers.

Methods: It was a cross-sectional study using a comparative approach to assess the relationship with the performance-based financing scheme and the community services delivery. We used a stratified random sampling and inferential statistics used chi square and logistic regression.

Results: The occupation of CHWs was significantly associated with counselling for early ANC (p=0.002), women attending early ANC and 4 ANC visits (p=0.000). Female were about 3 times likely to refer FP clients for FP methods uptake [p=0.043, CI= (1.030; 7.462), OR=2.773]. Farmers were 11 times as likely to perform this task as CHWs with other functions [p=0.000, CI= (3.890; 32.733), OR=11.284]. The CHWs who received 9 equipment and above [p=0.037, CI= (1.101)].

Conclusions: The community performance-based financing has a significant relationship with the community health workers service delivery and should be enhanced by trainings, formative supervision, and provision of equipment. Occupation was identified as to predict this association. But further studies be conducted to establish other factors that complement the community performance-based financing in community services delivery.



Igna B, Robert S, Ellen VP, Olivier B, Longin G, Frank VL, et al. Introduction of performance-based financing in burundi was associated with improvements in care and quality. Health Affairs 2014;33(12):2179.

Elisabeth P. Performance-based financing to strengthen the health system in Benin: challenging the mainstream approach. Int J Health Policy Manag. 2018;7(1):35-47.

Godfrey BZ, Philip G, Robert ADO, John FM, Rogers A. The effects of performance-based financing on the health centres of Jinja Diocese, Uganda. Int J Public Health Res. 2015;3(4):162-7.

Eichler R, Levine R. Performance incentives for global health: potential and pitfalls. CGD Books; 2009.

Adrien R, Olivier B. Community PBF Project in Makamba Province- Appraisal Report, Bujumbura. March 2013.

MOH Burundi. Manual of procedures for the implementation of performance-based financing at the community level. Bujumbura. 2017.

Denys N. Assessment of community health workers’ incentives on maternal and newborn health services performance, in Rwinkwavu district hospital, Kayonza District, Rwanda. Bugema University, Uganda. 2015.

Ndedda C, Annah W, Meshack N, David W, Gilbert W, Patrick W, et al. Effects of selected socio-demographic characteristics of community health workers on performance of home visits during pregnancy: a cross-sectional study in Busia District, Kenya. Glob J Health Sci. 2012;4(5):78-90.

Gisore P, Rono B, Marete I, Nekesa-Mangeni J, Tenge C, Shipala E, et al. Commonly cited incentives in the community implementation of the emergency maternal and newborn care study in Western Kenya. Afr Health Serv. 2013;13(20):461-8.

Greenspan JA, McMahon SA, Chebet JJ, Maurus M, David PU, Peter JW. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Res Health. 2013;11:52.

Wanduro P, Tetui M, Tuhebwe D, Ediau M, Okuga M, Nalwadda C, et al. The performance of community health workers in management of multiple childhood infectious diseases in Lira, Nohern Uganda- a mixed methods cross sectional study. Glob Health Act. 2016;9(1):33194.

Gopalan SS, Mohanty S, Das A. Assessing community health workers’ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ Open. 2012;2(5):e001557.

Armande KS, Ayodele SJ, Jesca SS, Mohamadou S, Ikeoluapo OA, Asaf T, et al. Motivation of community health workers in diagnosing, treating, and referring sick young children in a multicountry study. Clin Infect Dis. 2016;63(suppl_5):S270-5.




How to Cite

Gervais, M., Odongo, A. O., & Maima, A. (2022). Effects of community performance-based financing on community health workers’ service delivery in Kayanza health district, Burundi. International Journal Of Community Medicine And Public Health, 10(1), 21–28. https://doi.org/10.18203/2394-6040.ijcmph20223521



Original Research Articles