World Bank2013-03-292013-03-292008-06-23https://hdl.handle.net/10986/13063One of the main explanations put forth on why access to health workers is so low in developing countries is that there are insufficient resources within the public sector to pay the wage bill - the salary and allowance payments - of an expanded health workforce. In turn, the lack of wage bill resources for the health sector is thought to be a direct result of restrictive macroeconomic policies that limit the expansion of the overall public sector wage bill. The overarching message in this report is that, despite the relative contraction of the public sector wage bill, Rwanda has not only protected the health sector, but has succeeded through decentralization and the introduction of performance-based financing in linking salaries to performance in the health sector. The decentralization of budgets, along with the implementation of the performance-based grants scheme, has had two major effects. First, it has increased the resource envelope available for hiring health workers since there is a lot of flexibility in how the performance based grants can be used. Second, it has linked payments to health workers with performance, since the salary top amounts paid out of the grants are linked to service delivery results.en-USCC BY 3.0 IGOACCOUNTINGAGE STRUCTUREALLOCATIONANNUAL BUDGETANNUAL BUDGET PREPARATIONANNUAL BUDGETSANNUAL REPORTARTICLEBLOCK GRANTBLOCK GRANTSBUDGET CYCLEBUDGET ENVELOPEBUDGET EXECUTIONBUDGET FRAMEWORKBUDGET LAWBUDGET MANAGEMENTBUDGET MANAGEMENT PROCESSBUDGET SUPPORTBUDGETARY ITEMSBUDGETING PROCESSCAPACITY CONSTRAINTSCENTRAL GOVERNMENTCIVIL SERVANTSCIVIL SERVICECIVIL SERVICE REFORMCIVIL SERVICE SYSTEMCOMMUNITIESCONDITIONALITYCONTRACTUAL ARRANGEMENTSDECENTRALIZATIONDECENTRALIZATION POLICIESDECENTRALIZATION PROCESSDESCRIPTIONDOCTORSDONOR AGENCIESDONOR COORDINATIONDONOR FINANCINGDONOR FUNDINGDONOR FUNDSECONOMIC DEVELOPMENTECONOMIC GROWTHECONOMIC POLICYEXPENDITURE CEILINGSEXPENDITURE CONSTRAINTEXPENDITURE LEVELSEXPENDITURESFINANCIAL INSTITUTIONSFINANCIAL RESOURCESFISCAL DECENTRALIZATIONFISCAL DEFICITGENDERGOVERNMENT BUDGETGOVERNMENT EXPENDITUREGOVERNMENT EXPENDITURESGOVERNMENT STRUCTURESGROSS DOMESTIC PRODUCTHEALTH BUDGETSHEALTH CAREHEALTH CARE WORKERSHEALTH CENTERSHEALTH EXPENDITUREHEALTH EXPENDITURESHEALTH FACILITIESHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH PLANNINGHEALTH PROFESSIONALSHEALTH PROVIDERSHEALTH SECTORHEALTH SERVICEHEALTH SERVICE DELIVERYHEALTH SERVICESHEALTH SPENDINGHEALTH SYSTEMHEALTH WORKERSHEALTH WORKFORCEHIV/AIDSHOSPITAL DISTRICTSHOSPITAL PERSONNELHOSPITALSHOUSINGHRHUMAN RESOURCE MANAGEMENTHUMAN RESOURCESINCENTIVE STRUCTURESINCOMELABOR MARKETLAWSLOCAL REVENUELOW-INCOME COUNTRIESMACROECONOMIC POLICIESMANAGEMENT RESPONSIBILITIESMARKET DISTORTIONMEDIUM TERM EXPENDITUREMEDIUM TERM EXPENDITURE FRAMEWORKMEDIUM-TERM EXPENDITUREMEDIUM-TERM EXPENDITURE FRAMEWORKMINISTRY OF ECONOMYMINISTRY OF FINANCEMISMANAGEMENTNATIONAL BUDGETNATIONAL HEALTHNATIONAL STRATEGYNET LENDINGOPERATING EXPENDITURESORGANIZATIONAL STRUCTUREPERFORMANCE CONTRACTSPERFORMANCE CRITERIAPERFORMANCE EVALUATIONPERFORMANCE EVALUATIONSPERFORMANCE TARGETSPOVERTY REDUCTIONPOVERTY REDUCTION STRATEGYPROBABILITYPROFESSIONAL ASSOCIATIONSPROGRAMSPUBLIC ADMINISTRATIONPUBLIC EXPENDITUREPUBLIC EXPENDITURE REVIEWPUBLIC FUNDINGPUBLIC HEALTHPUBLIC INFORMATIONPUBLIC INSTITUTIONSPUBLIC INVESTMENTSPUBLIC SECTORPUBLIC SECTOR EMPLOYMENTPUBLIC SECTOR MANAGEMENTPUBLIC SERVICEPUBLIC SERVICESQUALITY ASSURANCEQUALITY OF HEALTHRECURRENT EXPENDITURESREVENUE PROJECTIONSREVENUE SOURCESRURAL AREASSALARY PAYMENTSSECTOR BUDGETSERVICE DELIVERYSERVICE EMPLOYMENTSERVICE PROVISIONSHARE OF HEALTH EXPENDITURESHARE OF HEALTH SPENDINGSOCIAL SERVICESTOTAL EXPENDITURETOTAL SPENDINGTUBERCULOSISURBAN AREASWAGE EXPENDITUREWORKERSWorld Bank10.1596/13063