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. |