Early evidence from results-based financing in rural Zimbabwe

摘要

Results-based financing (RBF) is an innovative approach to health system financing which pays providers for verified outputs. In July 2011, through a World Bank grant, Zimbabwe commenced an RBF project to improve utilization of quality maternal, neonatal and child health (MNCH) services. This article discusses its early results. A statistical analysis of intervention districts and control districts shows that RBF districts demonstrate higher increases in utilization levels for the MNCH services than control districts. Month-on-month growth rates for antenatal care, perinatal referrals and growth monitoring are statistically significant after the intervention, whilst they were not before the intervention and no significant trend was found in control districts. Qualitative study provides insight in the mechanisms through which RBF contributed to better performance: the use of contracts, increased autonomy of health facilities, increased community involvement, intrinsic motivation of health-care workers, existence of a reliable health information system, abolishment of user fees, improved supervision of health facilities, separation of functions, and the Government of Zimbabwe’s results-based management (RBM) policy.