A Qualitative Analysis of Organizational Changes That Were Steered by the Results-Based Finance Program in Zimbabwe

The study analyzes qualitatively the organizational changes steered by the Results Based Finance program (RBF) in Zimbabwe using a case study of Marondera and Zvishavane districts. The research findings are based on the key informants’ responses from focus group discussions and in-depth interviews. Some qualitative information was sourced from field observations and institutional RBF reports. It was established that significant organizational changes had been driven since the launch of the RBF program in the Marondera and Zvishavane districts in 2011. The changes were categorically stipulated in the RBF program implementation manual. The responsibilities of executive members at both the district and provincial levels expanded. Some of the changes include the introduction of District Steering Committees (DSCs) and Community Based Organizations (CBOs). Furthermore, Health Centre Committees (HCCs) were engaged in implementing the RBF program. Nevertheless, the organizational changes were not augmented by capacity building and empowerment amongst the CBOs, HCCs, and DSCs. Moreover, there was no adequate material and financial support for the new changes. Thus, there is a need to reinforce the organizational changes of health financing programs through robust capacity building among stakeholders engaged.

REFERENCES:

• Antony, M., Bertone, M. P., & Barthes, O. (2017). Exploring implementation practices in results-based financing: The case of the verification in Benin. BMC Health Services Research, 17(1), 1–12. https://doi.org/10.1186/s12913-017-2148-9
• Bergman, R., Forsberg, B. C., & Sundewall, J. (2021). Results-Based Financing for Health: A Case Study of Knowledge and Perceptions Among Stakeholders in a Donor-Funded Program in Zambia. Global Health Science and Practice, 9(4), 936–947. https://doi.org/10.9745/GHSP-D-20-00463
• Brown, P. G. W. (2018). Applying a Theory of Change in results-based financing : Findings from Zimbabwe. May.
• Crown Agents. (2019). Driving Team Work and Collaboration to Achieve UHC *. December.
• Fichera, E., Anselmi, L., Gwati, G., Brown, G., Kovacs, R., & Borghi, J. (2021). Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe. Social Science and Medicine, 279, 113959. https://doi.org/10.1016/j.socscimed.2021.113959
• James, N., Lawson, K., & Acharya, Y. (2020). Evidence on result-based financing in maternal and child health in low- and middle-income countries: a systematic review. Global Health Research and Policy, 5(1), 1–15. https://doi.org/10.1186/s41256-020-00158-z
• Kadungure, A., Brown, G. W., & Loewenson, R. (2020). Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe. https://doi.org/10.1108/JHOM-06-2020-0215
• Kane, S., Gandidzanwa, C., Mutasa, R., Moyo, I., Sismayi, C., Mafaune, P., & Dieleman, M. (2019). Coming full circle: How health worker motivation and performance in results-based financing arrangements hinges on strong and adaptive health systems. International Journal of Health Policy and Management, 8(2), 101–111. https://doi.org/10.15171/ijhpm.2018.98
• Marchal, B., Abejirinde, O. O., Sulaberidze, L., Chikovani, I., Uchaneishvili, M., Shengelia, N., Diaconu, K., Vassall, A., Zoidze, A., Giralt, A. N., & Witter, S. (2021). How do participatory methods shape policy ? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia. 1–11. https://doi.org/10.1136/bmjopen-2020-047948
• Mhazo, A. T., & Maponga, C. C. (2022a). Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa. BMJ Global Health, 7(12). https://doi.org/10.1136/bmjgh-2022-010228
• Mhazo, A. T., & Maponga, C. C. (2022b). The political economy of health financing reforms in Zimbabwe: a scoping review. International Journal for Equity in Health, 21(1), 1–14. https://doi.org/10.1186/s12939-022-01646-z
• Ministry of Health and Child Care. (2021). N. 1–104.
• Ministry of Health and Child Care Zimbabwe. (2019). Financing program (Issue December).
• Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses, and assistant nurses. BMC Health Services Research, 20(1), 1–8. https://doi.org/10.1186/s12913-020-4999-8
• Ridde, V., Antwi, A. A., Boidin, B., Chemouni, B., Hane, F., & Touré, L. (2018). Time to abandon amateurism and volunteerism: Addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa. BMJ Global Health, 3. https://doi.org/10.1136/bmjgh-2018-001056
• Seppey, M., Ridde, V., Touré, L., & Coulibaly, A. (2017). Donor-funded project’s sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali. Globalization and Health, 13(1), 86. https://doi.org/10.1186/s12992-017-0307-8
• Ssengooba, F., Ssennyonjo, A., Musila, T., & Ekirapa-Kiracho, E. (2021). Momentum for policy change: alternative explanations for the increased interest in results-based financing in Uganda. Global Health Action, 14(1). https://doi.org/10.1080/16549716.2021.1948672
• Ssennyonjo, A., Ekirapa–Kiracho, E., Musila, T., & Ssengooba, F. (2021). Fitting Health Financing Reforms to Context: Examining the Evolution of Results-Based Financing Models and the Slow National Scale-Up in Uganda (2003–2015). Global Health Action, 14(1). https://doi.org/10.1080/16549716.2021.1919393
• The World Bank. (2013). Using Results-Based Financing to Achieve Maternal & Child Health. World Bank.
• The World Bank. (2015). Process Monitoring and Evaluation II of Zimbabwe’s Results -Based Financing Project.
• Vergeer, P., Heard, A., Josephson, E., & Fleisher, L. (2017). Verification in Results-Based Financing for Health. Verification in Results-Based Financing for Health. December. https://doi.org/10.1596/26040
• Williams, M. (2023). Financing the Blue Economy: Impacts and Implications for Gender Equality and Women’s Empowerment in the Global South.
• Witter, A. S., Chirwa, Y., Chandiwana, P., Munyati, S., Pepukai, M., & Bertone, M. (2019). The political economy of results-based financing: the experience of the health system in Zimbabwe, 5, 1–17.
• Witter, S., Bertone, M. P., Namakula, J., Chandiwana, P., Chirwa, Y., Ssennyonjo, A., & Ssengooba, F. (2019). (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo. Global Health Research and Policy, 4(1). https://doi.org/10.1186/s41256-019-0094-2
• World Bank. (2016). Rewarding Provider Performance to Improve Quality and Coverage of Maternal and Child Health Outcomes. Zimbabwe Results-Based Financing Pilot Program. Evidence to Inform Policy and Management Decisions. July 2015, 1–95. https://www.rbfhealth.org/sites/rbf/files/documents/Zimbabwe-Impact-Evaluation-Overview-Report.pdf