Cataract is responsible for 57% of blindness and vision impairment in Rwanda. The cataract surgical rate in Rwanda is less than 500 surgeries per million people, just a quarter of the World Health Organization (WHO) target for Sub-Saharan Africa. 

In an effort to increase the cataract surgical output in a sustainable way, The Fred Hollows Foundation is piloting a new model of service provision by integrating cataract and eye care service indicators into the Performance Based Financing (PBF) model governed by the Ministry of Health (MoH) in Rwanda.

The Rwanda program is supported by the Australian Government through the Australian NGO Cooperation Program (ANCP).



This project will adopt the PBF model of implementation, with the aim to integrate eye health service delivery into the existing model. 

This model has already been in operation in Rwanda since 2008 across the Rwandan health care system. The MoH has shown great interest in assisting The Foundation in scaling up its impact in Rwanda through supporting the integration of eye health into the PBF as a chief means of achieving the objectives laid out in the current five-year national eye health plan. 

The MoH has signalled its commitment to dedicating an eye care resource who will be responsible for overseeing and regularly monitoring activities implemented through this project. 

We believe that working through a PBF model, The Foundation has an opportunity to build on the investment the government is already making in eye health in order to boost cataract surgical output, while also working to strengthen quality, equity and the health system itself, in the process. 


PBF Implementation in Rwanda will be implemented through three key steps: 

1. The MoH establishes a contract that defines provider (health facilities) performance targets and the amount of payment it will receive from the purchaser (Ministry of Finance and partners) for achieving those targets 

2. Results in attaining performance targets are verified on a regular basis by an independent agency 

3. Based on verification, the provider receives payment according to the level at which they achieved the agreed 4 targets


Helping people see

  • 67,519 people screened
  • 4,360 eye operations and treatments performed including:
  • 1,378 cataract operations
  • 245 diabetic retinopathy treatments
  • 2,737 other sight saving or improving interventions

Investing in people

  • 227 people trained
  • 92 community members educated in eye health