|RBF adoption process||
– RBF introduced since 2005 (earliest RBF adopted among the three cases)|
– First RBF project in South Kivu implemented by the NGO Cordaid
– Followed by a number of other projects funded by the European Union, World Bank, USAID, and other NGOs in different provinces [1, 45].
– Since 2011 |
– WB-funded and Cordaid-implemented pilot in two districts (Marondera and Zvishavane), then in an additional 16 districts
– Scaled up to cover the entire country in 2014: HDF-funded and Crown Agents-implemented
– Since 2009|
– Numerous RBF schemes, all donor funded, with the World Bank being one of the major donors [57,58,59], but also other schemes implemented by Cordaid in Jinja (2009–2015) and recently by the Belgian Development Agency, Enabel (formerly BTC) in West Nile and Rwenzori regions.
|Main reasons of RBF adoption||Policy vacuum left room for NGO/donor-led experiments||Resource constraints as trigger for RBF adoption||RBF adopted to mitigate financial constraints in private sector and improve services across the country, including in the North|
|Focus of this study||
EU-funded project (9th FED) and the ongoing World Bank-funded Programme de Développement de Services de Santé project (PDSS).|
The reason is that both schemes make use of newly-created semi-autonomous purchasing agencies (établissements d’utilité publique, EUPs – see Annex 1).
|Both RBF schemes, covering the entire country||
RBF pilots in the post-conflict northern region|
– World Bank’s Saving Mothers, Giving Lives (SMGL) (2012–2017)
– DFID’s NuHealth (2011–2016)
– USAID’s Strengthening Decentralisation for Sustainability (SDS) (2011–2017).
|Impact evaluation||No impact evaluation published so far for the selected RBF programmes||An impact evaluation has been conducted by the World Bank in the original districts . However, no independent research on RBF’s health system effects has yet been published.||Mid-term impact for SMGL shows a 30% reduction in maternal death. Other programmes are yet to be evaluated.|