Abstract
In 2015, the Zambian government and the Swedish International Development Cooperation Agency (Sida) signed an agreement in which Sida committed to funding a program for Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH). The program includes a results-based financing (RBF) model that aims to reward Zambian districts for improved district-wide results on relevant indicators with additional funding. We aimed to describe stakeholders' knowledge of the RBF model and perceptions of the incentive structure during the first 18 months of the program's implementation. This study illuminates the possible pitfalls of implementing an RBF scheme without giving attention to all necessary steps of the process. A qualitative case study was used and included a review of documents, in-depth interviews, and observations. From February-April 2017, we conducted 37 in-depth interviews, representing the views of 12 development partner agencies, government departments, and health facility staff throughout Zambia. We used a qualitative framework analysis. Findings show that the Zambian government and Sida had different perceptions on what levels of the health system RBF will incentivize and that most districts and hospital administrators interviewed were unaware of the indicators that the RBF was part of the RMNCAH program at all. The lack of knowledge about the RBF scheme among respondents suggests the possibility that the model did not ultimately have the necessary preconditions to create an effective incentive structure. These results demonstrate the need for improved communication between stakeholders and the importance of sufficiently planning an RBF model before implementation.
Highlights
IntroductionResults-based financing (RBF) is an umbrella term used to describe any program in which a funder— often a national government or agency, or a foreign development partner—transfers money, material goods, or other incentives to a recipient agent conditional on the recipient achieving predefined output or outcome targets.[1,2,3] An incentive is anything that motivates or encourages the agent to achieve the desired results that are agreed upon with the funder.[4,5] not distinct from RBF, results-based aid refers to cases in which a bi- or multilateral development partner funds a national government of a partner country and the national government bears the responsibility of delivering results.[2,6] Development partners typically see results-Case Study of Results-Based Financing in Zambia www.ghspjournal.org based mechanisms as methods to make aid more effective
Not distinct from Results-based financing (RBF), results-based aid refers to cases in which a bi- or multilateral development partner funds a national government of a partner country and the national government bears the responsibility of delivering results.[2,6]
An RBF scheme might benefit from being iterated throughout the implementation period, it is recommended that a flexible plan is in place for a program during the initial phase of implementation so that all actors have at least basic knowledge and understanding from the onset on its intended results and incentive structure
Summary
Results-based financing (RBF) is an umbrella term used to describe any program in which a funder— often a national government or agency, or a foreign development partner—transfers money, material goods, or other incentives to a recipient agent conditional on the recipient achieving predefined output or outcome targets.[1,2,3] An incentive is anything that motivates or encourages the agent to achieve the desired results that are agreed upon with the funder.[4,5] not distinct from RBF, results-based aid refers to cases in which a bi- or multilateral development partner funds a national government of a partner country and the national government bears the responsibility of delivering results.[2,6] Development partners typically see results-Case Study of Results-Based Financing in Zambia www.ghspjournal.org based mechanisms as methods to make aid more effective. Oxman and Fretheim provided an overview of systematic reviews analyzing RBF schemes in lower- and middle-income countries (LMICs) They outlined 7 characteristics that can differ between RBF* programs, including the indicators chosen to measure results, the method by which results are measured, the type and magnitude of incentives used, and the level of a government or sector incentivized.[1] their overview, as well as other systematic reviews, shows that there is insufficient evidence to support the concept that RBF leads to better performance, whether it is used to incentivize individuals or entire levels of a sector.[2,8] Many studies of RBF programs lack adequate controls that would allow impact to be assessed.[6] Even when studies have used a randomized control trial design to control for confounders, they have been inconclusive on the impact of RBF.[6,9] evidence from a variety of settings points to the various risks and perverse effects RBF can have.[9]
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