Achieving value: A case study of the One Family Health care delivery model in the Context of Rwanda’s Vision for Universal Health Coverage

Abstract

Background: Healthcare systems such as that of Rwanda face barriers in terms of infrastructural, financial, human, and technical resources. The value-based care framework offers an approach to examining health delivery systems facing resource-constraints and to highlight areas for greater progression towards maximizing impact on health outcomes given resource limitations. Methods: A qualitative approach was used to explore One Family Health’s care delivery model and its challenges and successes using value-based care as an underlying analytic framework. Primary data in the form of 8 qualitative semi-structured interviews were combined with secondary data from 14 previously conducted semi-structured interviews. Thematic analysis was applied to analyze the data. Results: Successes indicate OFH contribution to expanding access to care in Rwanda and challenges of the OFH health post model point to financing model and its relation to Rwanda’s recent financing changes. Quality of service delivery at the OFH health post approximately indicate strengths in patient-centeredness and equity and weaknesses in safety and efficiency. An anecdotal exploration of health outcomes suggest that individual patients improve as a result of visiting the health post and that the health post contributes to community wellbeing particularly in terms of health education and reducing the burden on health centers. Barring a small and biased sample, OFH nurses seem to be satisfied with the health post model, though their experience could be improved with routine training and increased supervision. Insights in integration and alignment in the context of the public-private partnership were also discussed. Conclusions: The One Family Health qualitative case study utilizing the value-based care framework offers several lessons for One Family Health, Rwanda Ministry of Health as it continues to contract with private sector entrepreneurs, and for further research that involves the application of the value-based care framework. These lessons include aligning its financial model with the aims of government financing initiatives, providing infrastructural and financial supports, and routine monitoring of health outcomes centered on patients as well as provider satisfaction and support.