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Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe

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  • Fichera, Eleonora
  • Anselmi, Laura
  • Gwati, Gwati
  • Brown, Garrett
  • Kovacs, Roxanne
  • Borghi, Josephine

Abstract

Result Based Financing (RBF) has been implemented in health systems across low and middle-income countries (LMICs), with the objective of improving population health. Most evaluations of RBF schemes have focused on average programme effects for incentivised services. There is limited evidence on the potential effect of RBF on health outcomes, as well as on the heterogeneous effects across socio-economic groups and time periods. This study analyses the effect of Zimbabwe's national RBF scheme on neonatal, infant and under five mortality, using Demographic and Health Survey data from 2005, 2010 and 2015. We use a difference in differences design, which exploits the staggered roll-out of the scheme across 60 districts. We examine average programme effects and perform sub-group analyses to assess differences between socio-economic groups. We find that RBF reduced under-five mortality by two percentage points overall, but that this decrease was only significant for children of mothers with above median wealth (2.7 percentage points) and education (2.1 percentage points). RBF increased institutional delivery by seven percentage points – with a statistically significant effect for poorer socio-economic groups and least educated. We also find that RBF reduced c-section rates by three percentage points. We find no detectable effect of RBF on other incentivised services. When considering programme effects over time, we find that effects were only observed during the second phase of the programme (March 2012) with the exception of c-sections, which only reduced in the longer term. Further research is needed to examine whether these findings can be generalised to other settings.

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  • Fichera, Eleonora & Anselmi, Laura & Gwati, Gwati & Brown, Garrett & Kovacs, Roxanne & Borghi, Josephine, 2021. "Can Results-Based Financing improve health outcomes in resource poor settings? Evidence from Zimbabwe," Social Science & Medicine, Elsevier, vol. 279(C).
    • Handle: RePEc:eee:socmed:v:279:y:2021:i:c:s0277953621002914
    DOI: 10.1016/j.socscimed.2021.113959
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    1. Bonfrer, Igna & Van de Poel, Ellen & Van Doorslaer, Eddy, 2014. "The effects of performance incentives on the utilization and quality of maternal and child care in Burundi," Social Science & Medicine, Elsevier, vol. 123(C), pages 96-104.
    2. Laurence Lannes & Bruno Meessen & Agnes Soucat & Paulin Basinga, 2016. "Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(3), pages 309-348, July.
    3. Ellen Van de Poel & Gabriela Flores & Por Ir & Owen O'Donnell, 2016. "Impact of Performance‐Based Financing in a Low‐Resource Setting: A Decade of Experience in Cambodia," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 688-705, June.
    4. Paul Gertler & Christel Vermeersch, 2013. "Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes," NBER Working Papers 19046, National Bureau of Economic Research, Inc.
    5. De Walque,Damien B. C. M. & Robyn,Paul Jacob & Saidou,Hamadou & Sorgho,Gaston & Steenland,Maria Ward, 2017. "Looking into the performance-based financing black box: evidence from an impact evaluation in the health sector in Cameroon," Policy Research Working Paper Series 8162, The World Bank.
    6. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    7. Gabriella Conti & Mark Hanson & Hazel Inskip & Sarah Crozier & Cyrus Cooper & Keith Godfrey, 2018. "Beyond Birth Weight: The Origins of Human Capital," Working Papers 2018-089, Human Capital and Economic Opportunity Working Group.
    8. Elise Huillery & Juliette Seban, 2021. "Financial Incentives, Efforts, and Performances in the Health Sector: Experimental Evidence from the Democratic Republic of Congo," Economic Development and Cultural Change, University of Chicago Press, vol. 69(3), pages 1115-1164.
    9. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
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