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Table 5 Summary of key actors’ positions on RBF over time in Zimbabwe

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

Actors Initial position on RBF Evolution of position over time
Ministry of Health Initial distrust and lack of knowledge about RBF Key managers at national level take ownership, though residual concerns remain about it being another ‘vertical’ approach; resistance is also felt from programme managers uninvolved in RBF.
Provincial Medical Directors and DHEs appreciate it as bringing supportive resources and tools
PHUs gain relatively flexible resources, although are concerned about fall in budgets and intensive procurement procedures; hospitals have not benefited significantly to date though the policy is now being extended to district hospitals in all areas.
Staff at PHUs benefited from incentives but have some concerns, especially over how they are distributed internally.
Ministry of Finance Thought to be supportive of this as enabling an (adapted) trial of results based management The MoF has supported RBF with some co-financing in the World Bank-supported districts; may be interested to extend to other sectors; however, the on-going resource squeeze is a major constraint.
Communities No prior exposure Communities have benefits from important inputs in the quality of care at PHU level, though effects on financial protection are not so clear.
HCCs have gained from acquiring resources to manage; however, wider links with and accountability to communities continue to be limited.
Development partners Most development partners initially perceive this as a World Bank project; some early resistance to the approach Gradually won over by what seem to be promising early results; later support roll-out, though there are concerns about the model being ‘over-sold’ by a number of development partners. They see gains as the result of a wide range of system-supporting interventions which happened concomitantly.
The World Bank is able to portray RBF as successful, although its own impact evaluation is more mixed.
Implementers Cordaid had long-standing expertise on operating RBF and was an advocate.
Crown Agents was initially less experienced.
Cordaid remains supportive of RBF and is supporting institutionalisation in its districts.
Crown Agents has gained experience of RBF and continues to operate the policy in HDF-supported districts, with UNICEF continuing as fund manager.