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Table 1 Summary of key features of RBF in the case studies

From: (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo

  DRC Zimbabwe Uganda
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 [12]
– 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 [42]. 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.