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dc.rights.licenseCreative Commons Attribution License 4.0.
dc.contributor.authorWitter, Sophieen
dc.contributor.authorChirwa, Yotamuen
dc.contributor.authorChandiwana, Pamelaen
dc.contributor.authorMunyati, Shunguen
dc.contributor.authorPepukai, Mildreden
dc.contributor.authorBertone, Maria Paolaen
dc.contributor.authorBanda, Steveen
dc.identifier.citationWitter, S., Chirwa, Y., Chandiwana, P., Munyati, S., Pepukai, M., Bertone, M.P. and Banda, S. (2020) ‘Results-based financing as a strategic purchasing intervention: some progress but much further to go in Zimbabwe?’, BMC Health Services Research, 20(1), p. 180. Available at:
dc.descriptionSophie Witter - ORCID 0000-0002-7656-6188
dc.descriptionMaria Paola Bertone - ORCID 0000-0001-8890-583X
dc.descriptionReplaced AM with VoR 2020-03-06
dc.description.abstractBackground 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.en
dc.description.abstractMethods The article is based on a documentary review, including 60 documents from 2008-2018, 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.
dc.description.abstractResults 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.
dc.description.abstractConclusions Our analysis suggests that RBF in Zimbabwe, at least at this early stage, is mainly functioning as an additional source of funding and as a provider payment mechanism, focussed on the primary care level for MCH services. RBF in this case brought focus to specific outputs but remained one provider payment mechanism amongst many, with limited traction over the main service delivery inputs and programmes. Zimbabwe’s economic and political crisis provided an important entry point for RBF, but Zimbabwe did not present a ‘blank slate’ for RBF to reform: it was a functional health system pre-crisis, which enabled relatively swift scale-up of RBF but also meant that the potential for restructuring of institutional purchasing relationships was limited. This highlights the need for realistic and contextually tailored expectations of RBF.
dc.description.sponsorshipThe work was funded by UK Aid through the ReBUILD consortium, however, the funders have no responsibility for the content of this article.en
dc.relation.ispartofBMC Health Services Researchen
dc.rights© The Authors
dc.subjectResults-based Financingen
dc.subjectStrategic Purchasingen
dc.subjectMaternal And Child Health Careen
dc.subjectPerformance-based Financingen
dc.titleResults-based financing as a strategic purchasing intervention: Some progress but much further to go in Zimbabwe?en
rioxxterms.typeJournal Article/Reviewen
qmu.authorWitter, Sophieen
qmu.authorBertone, Maria Paolaen
qmu.centreInstitute for Global Health and Developmenten

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Except where otherwise noted, this item's license is described as Creative Commons Attribution License 4.0.