From Scheme to System (Part 1): Notes on Conceptual and Methodological Innovations in the Multicountry Research Program on Scaling Up Results-Based Financing in Health Systems

Abstract

This article presents conceptual and methodological developments made in analyzing the scale up of results-based financing (RBF) as part of a multicountry research program supported by the Alliance for Health Policy and Systems Research. Following a brief overview of the research process, the article proposes a new five-dimensional conceptualization of scale-up (population coverage, service coverage, health system integration, cross-sectoral diffusion, and knowledge expansion) to capture various facets of RBF scale-up. It also presents how Walt and Gilson's health policy triangle framework was modified to identify the enablers and barriers to scale-up in the country case studies included in this research program. The article then puts forth a fourphase model of scale-up, including phases of generation, adoption, institutionalization, and expansion, developed for the purpose of this research program. The article concludes by providing some lessons learned on the use of the methods and theoretical frameworks developed for this multicountry research program.

Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?

“…Reflecting on [43], we find that Zimbabwe followed a particular trajectory, with geographic expansion occurring before institutionalisation, which reflects the history and political economy of the policy [13]. It seems clear that RBF benefited from the managerial capacity in Zimbabwe, which also enabled the MoHCC to take ownership of the programme and to ensure its adaptation to context [13].…”

“…Despite the limitations, this article adds to the limited literature on RBF in low and middle income countries and how it affects and makes more 'strategic' the existing purchasing arrangements. Based on our case study of Zimbabwe, it suggests that expectations of institutional reform and in particular the potential for RBF to drive a more strategic approach to purchasing [5] [4] should be moderated, particularly at early stages of RBF implementation [43] . Considering our strategic purchasing framework, we find (see summary in Table 3) that rather than systematically reforming strategic purchasing functions, in contexts like Zimbabwe's RBF adds a new provider payment mechanism into the mix, which can produce benefits, but also adds to a complex landscape and does not resolve many underlying challenges [44] [45] iv .…”

Taking Results-Based Financing from Scheme to System

“…Details on the research process and the findings from comparative analysis are provided in two articles in this special issue. 11,12 The empirical articles in this special issue on RBF are likewise based on the research program.…”

Stunted scale-up of a performance-based financing program on HIV and maternal–child health services in Mozambique — a policy analysis

“…The importance of this point cannot be overlooked. Although the evidence base for PBF in LMICs is lacking, PBF is not all that new or innovative and the broader literature on incentives-linked to performance supports their efficacy (Witter, Fretheim, Kessy, Lindahl, 2010;Scott et al, 2011;Meessen, Schroff, Ir, & Bigdeli, 2017). However, the health sector of Mozambique has unique attributes and poses specific challenges.…”

“…Overall, the evidence surrounding PBF remains mixed and the heterogeneity of settings and implementation makes the case for broader expansion or scale-up precarious. While scale-up of effective health interventions or strategies is considered essential to benefit more people, there is limited evidence on the factors that enable or hinder such processes, particularly for PBF (Meessen et al, 2017;Shroff, Bigdeli, & Meeseen, 2017). Scale-up is often interpreted as increasing geographical coverage from a limited study or program area to an entire region or country, but scale-up can expand beyond geographic coverage.…”