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Table 3 Timeline for RBF adoption, piloting and scale up

From: The political economy of results-based financing: the experience of the health system in Zimbabwe

Date Key events
2008 Peak of political/economic crisis in Zimbabwe
2009 Government of National Unity (GNU) takes power. 2009–13 National Health Strategy lays out plan for post-crisis recovery
2008–10 World Bank engages the Ministry of Health and Child Care (MoHCC) in discussion of RBF
July 2011 Pilots start in two ‘front-runner’ districts. National RBF steering committee established.
January 2012 The Health Transition Fund (HTF) provides pooled donor support to maternal, newborn and child health and health system strengthening – paying allowances to key staff, purchasing essential drugs and equipment, fixed amounts to rural health centres (RHCs) ($750 per quarter per clinic) across the country
March 2012 RBF pilot scaled up to 18 districts (two per province), managed by Cordaid and funded by the World Bank. First programme implementation manual (PIM) developed. Indicators focused on maternal and child services in primary clinics (public and mission sectors) but with support to referral facilities for specific indicators.
HTF continues to support all districts with equipment, medicines and retention allowances but stops financial support to RBF clinics (fixed allowance continues to remaining 42 districts).
2012 World Bank Technical Review undertaken; first RBF price adjustment
2013 Mid-term review of Cordaid programme; prices adjusted for some indicators; quality bonuses shift to threshold-based system; greater weight given to clinical quality in quality checklist
2014 HTF adopts output-based model in 42 districts for primary care units only (because of resource constraints, district hospitals continue to receive fixed amounts in the 42 districts). UNICEF launches tender for implementation, which Crown Agent wins. Cordaid shares its model and helps to train staff in the 42 new districts.
2016 Impact evaluation of RBF in 18 districts shared23, 52. Zimbabwe hosts global RBF workshop, with World Bank support. Quality checklist revised.
HTF transitions to Health Development Fund (HDF).
2017 Review of indicators and quantity/quality weighting, following health system assessment (focusing on RBF, human resources and pharmaceuticals). Staff bonus is linked to quality scores. Technical working group for sustainability established. Prices for indicators drop due to budget constraints.
November 2017 Political upheaval and start of ‘new dispensation’ led by Emmerson Mnangagwa.
2018 Institutionalisation plan aims to shift functions from external contractors to the Project Coordination Unit in MoHCC for 18 districts in 2018. MoF contribution to funding increased. District hospitals to be included in RBF programme for all districts.