Table 1 Summary of key features of RBF in the case studies
| Â | 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. |