Introducing a sector-wide pooled fund in a fragile context: mixed-methods evaluation of the health transition fund in Zimbabwe

Abstract

IntroductionAid effectiveness and improving its impact is a central policy matter for donors and international organisations. Pooled funding is a mechanism, whereby donors provide financial contributions towards a common set of broad objectives by channelling finance through one instrument. The results of pooled funds as an aid mechanism are mixed, and there is limited data on both methodology for, and results of, assessment of effectiveness of pooled funding.MethodsThis study adapted a conceptual framework incorporating the Paris Principles of Aid Effectiveness and qualitative methods to assess the performance of the Health Transition Fund (HTF) Zimbabwe. 30 key informant interviews, and 20 focus group discussions were conducted with informants drawn from village to national level. Descriptive secondary data analysis of Demographic Health Surveys, Health Management Information Systems (HMIS) and policy reports complemented the study.ResultsThe HTF combined the most optimal option to channel external aid to the health sector in Zimbabwe during a period of socioeconomic and political crisis. It produced results quickly and at scale and enhanced coordination and ownership at the national and subnational level. Flexibility in using the funds was a strong feature of the HTF. However, the initiative compromised on the investment in local capacity and systems, since the primary focus was on restoring essential services within a nearly collapsed healthcare system, rather than building long-term capacity. Significant changes in maternal and newborn health outcomes were observed during the HTF implementation in Zimbabwe.ConclusionA framework which can be used to assess pooled funds was adapted and applied. Future assessments could use this or another framework to provide new evidence regarding effectiveness of pool donor funds although the frameworks should be properly tested and adapted in different contexts.

Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

“…Stabilisation of the economy from 2009 onwards from the 2000 to 2008 economic crisis led to stabilising of the health system and reduction of maternal mortality from the high levels of 2007–2008. 74 However, health system constraints have resurfaced due to the rebounded economic challenges. 16 The causes of death analysis showed a huge decline in deaths from indirect causes—mainly HIV deaths, due to increased ART coverage.…”

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study

“…Thus, we expect ART to have reduced maternal mortality due to HIV, as seen in other SSA studies [ 62 ]. Other interventions implemented during this period, such as massive donor funding for maternal and child health programs through the health transition and health development funds, will be examined [ 63 ].…”

The political economy of health financing reforms in Zimbabwe: a scoping review

“…Ideologically, RBF is in tandem with the ideas of ‘new public management’ which emphasize ‘management by results’ [ 50 ]. The characterization of Zimbabwe as a fragile state also reinforced the idea of enhancing donor aid effectiveness in line with the principles of the 2005 Paris Declaration on Aid effectiveness that emphasized aspects such as transparency, harmonization and country ownership [ 48 ]. Alongside these donor funded initiatives, in 2017 the government introduced a 5% Mobile Airtime Levy (also known as health levy) ring fenced for procurement of medicines.…”

“…In a volatile social, economic, and political context characterized by deteriorating health indicators of humanitarian proportion, the Health Transition Fund (HTF) was designed as a multi-donor pooled fund aiming to support the government in inverting trends in maternal and child health with an allocated investment of US$235 million. The UK Department for International Development (DFID), the EU, the Governments of Ireland, Sweden, Norway and Canada were the major contributors to the fund with UNICEF as the fund manager [ 48 ]. Architects of pooled donor funds claim that the model might not dominate aid flow at country level but can significantly alter institutions since the mechanisms and processes involved (particularly joint planning and country ownership) can trigger new ways of donor collaboration in the wider environment.…”