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

Abstract

Background: Results-Based Financing (RBF) has proliferated in the health sectors of low and middle income countries, especially those which are fragile or conflict-affected, and has been presented by some as a way of reforming and strengthening strategic purchasing. However, few if any studies have empirically and systematically examined how RBF impacts on health care purchasing. This article examines this question in the context of Zimbabwe's national RBF programme. Methods: The article is based on a documentary review, including 60 documents from 2008 to 2018, and 40 key informant (KI) interviews conducted with international, national and district level stakeholders in early 2018 in Zimbabwe. Interviews and analysis of both datasets followed an existing framework for strategic purchasing, adapted to reflect changes over. Results: We find that some functions, such as assessing service infrastructure gaps, are unaffected by RBF, while others, such as mobilising resources, are partially affected, as RBF has focused on one package of care (maternal and child health services) within the wider essential health care, and has contributed important but marginal costs. Overall purchasing arrangements remain fragmented. Limited improvements have been made to community engagement. The clearest changes to purchasing arrangements relate to providers, at least in relation to the RBF services. Its achievements included enabling flexible resources to reach primary providers, funding supervision and emphasising the importance of reporting.(Continued on next page)

Recommendations to improve the insurance coverage for physiotherapy services in Iran A multi-criteria decision making approach

“…Based on the prioritization, using strategic purchasing had the highest rank. This result is consistent with the relevant evidence [37,38]. However, a major proportion of health care services such as physiotherapy, are provided by financing funds.…”

Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach

“…Based on prioritization, using strategic purchasing had the highest rank. These results were consistent with the relevant evidence [43,44]. However, a major proportion of health care services such as physiotherapy are provided by nancers.…”

Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe

“…A number of adaptions located in our study could be attributed to either programming shortcomings or exogenous pressures, suggesting that some drivers for adaptation are compounding or indeterminable. For example, a number of consistent moderating effects in Zimbabwe involved low staff numbers, poor remuneration and increased workload demands involved in RBF processes resulting from a general lack of staff, underscoring the fact that existing human resource deficiencies can significantly undermine RBF performance (Witter et al , 2020). However, it is not immediately clear whether these staff shortages are best attributed to initial underestimations and poor assumptions made within the RBF programme design (programme fault) and/or whether staff shortages should be attributed to broader health system conditions that affected the results of an otherwise properly designed RBF scheme (exogenous).…”