(How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Research and Policy
Abstract
Results-Based Financing (RBF) has proliferated in health sectors of low and middle income countries,
especially fragile and conflict-affected ones, and has been presented as a way of reforming and strengthening
strategic purchasing. However, few studies have empirically examined how RBF impacts on health care purchasing
in these settings. This article examines the effects of several RBF programmes on health care purchasing functions
in three fragile and post-conflict settings: Uganda, Zimbabwe and the Democratic Republic of Congo (DRC) over
the past decade.
Methods: The article is based on a documentary review, including 110 documents from 2004 to 2018, and 98 key
informant (KI) interviews conducted with international, national and district level stakeholders in early 2018 in the
selected districts of the three countries. Interviews and analysis followed an adapted framework for strategic
purchasing, which was also used to compare across the case studies.
Results: Across the cases, at the government level, we find little change to the accountability of purchasers, but
RBF does mobilise additional resources to support entitlements. In relation to the population, RBF appears to bring
in improvements in specifying and informing about entitlements for some services. However, the engagement and
consultation with the population on their needs was found to be limited. In relation to providers, RBF did not
impact in any major way on provider accreditation and selection, or on treatment guidelines. However, it did
introduce a more contractual relationship for some providers and bring about (at least partial) improvements in
provider payment systems, data quality, increased financial autonomy for primary providers and enforcing equitable
strategies. More generally, RBF has been a source of much-needed revenue at primary care level in under-funded
health systems. The context – particularly the degree of stability and authority of government–, the design of the
RBF programme and the potential for effective integration of RBF in existing systems and its stage of development
were key factors behind differences observed.
Description
Keywords
Results-based financing, Performance-based financing, Strategic purchasing, Mother and child health care, Uganda, DRC, Zimbabwe
Citation
Witter, S., Bertone, M. P., Namakula, J., Chandiwana, P., Chirwa, Y., Ssennyonjo, A., & Ssengooba, F. (2019). (How) does RBF strengthen strategic purchasing of health care? Comparing the experience of Uganda, Zimbabwe and the Democratic Republic of the Congo. Global Health Research and Policy, 4(1), 1-20.https://doi.org/10.1186/s41256-019-0094-2