#HSR2018 Poster 182
Poster title: The political economy of results-based financing: the experience of the health system in Zimbabwe
This poster is produced by IGHD's Sophie Witter, Yotama Chirwa, Pamela Chandiwana, Shungu Munyati, Mildred Pepukai and IGHD's Maria Bertone.
Presentation date & location: 10:30am on Friday 12th October (ACC Hall 2M) - poster number 182
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Results based financing (RBF) has been proliferating in health sectors in Africa in particular, and with a focus in fragile and conflict affected settings (FCAS), since 2000, and there is a growing but still contested body of literature about its relevance and effectiveness. Less examined are the political economy factors behind the adoption of policy, as well as understanding the shifts in influence and resources which RBF may bring about. In this article, we examine the RBF programme in Zimbabwe through a political economy lens, based on documentary review and 40 key informant interviews with local, national and international experts. Zimbabwe is one of the few national RBF programmes in Africa, having rolled out RBF nationwide in the health system over a period of years from 2011 with external support. Our findings highlight the role of donors in initiating the RBF policy, but also how the Zimbabwe health system was able to adapt the model to suits its particular circumstances – seeking, in particular, to maintain a systemic approach, and avoiding fragmentation by the RBF programme. Although Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s, it retained managerial and professional capacity, which distinguishes it from other FCAS settings. This active adaptation has engendered national ownership over time, despite initial distrust and resistance to the RBF model and despite the complexity of RBF, which creates dependence on external technical support. Adoption was also aided by ideological retro-fitting into an earlier government performance management policy. The main beneficiaries of RBF were frontline providers, who gained small but critical additional resources, but subject to high degrees of control and sanctions.
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