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Linking Results to Performance: Evidence from a Results Based Financing Pre-Pilot Project in Katete District, Zambia

Author

Listed:
  • Collins Chansa
  • Ashis Das
  • Jumana Qamruddin
  • Jed Friedman
  • Akafwilangachi Mkandawire
  • Monique Vledder

Abstract

Global interest in results based financing (RBF) as a means of strengthening health systems and improving service delivery coincides with heavy Zambian investment in its health sector—but with poor maternal and child health (MCH) outcomes. Determined to remedy the situation, Zambia pre-piloted an RBF project in Katete district aimed at testing how RBF can be adapted to the country context and its suitability in strengthening the health system and improving service delivery. This case study reviews the design and implementation of the Katete RBF Pre-Pilot and explores its impact on access and utilization of MCH services and health systems strengthening. The research team used a mixed-methods approach, collecting qualitative and quantitative data through semi-structured interviews, group discussions, document reviews and financial and health service delivery databases. Changes in performance indicators were estimated using an interrupted time series analysis complemented by a simulated modeling analysis. In Katete, RBF increased immunization coverage of children less than one year old by 4 percent and curative consultations by 14 percent between 2008 and 2012. These achievements were facilitated by some health system improvements such as increased managerial autonomy and local decision-making at service delivery levels, enhanced staff performance and teamwork, and community participation. Despite these gains, the project experienced some delays in RBF disbursements to health facilities and increased staff workload due to increased utilization of health services. The study revealed clients’ perceptions of high service quality despite low technical quality scores. RBF can be used to improve health system performance and service delivery quality. However, the implementation and effects of RBF are context-specific and the model has to meet certain key design criteria and requires basic inputs for RBF to work effectively.

Suggested Citation

  • Collins Chansa & Ashis Das & Jumana Qamruddin & Jed Friedman & Akafwilangachi Mkandawire & Monique Vledder, 2015. "Linking Results to Performance: Evidence from a Results Based Financing Pre-Pilot Project in Katete District, Zambia," Health, Nutrition and Population (HNP) Discussion Paper Series 98265, The World Bank.
    • Handle: RePEc:wbk:hnpdps:98265
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    References listed on IDEAS

    as
    1. Gertler, Paul & Vermeersch, Christel, 2012. "Using performance incentives to improve health outcomes," Policy Research Working Paper Series 6100, The World Bank.
    2. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    3. Jumana Qamruddin & Collins Chansa & Ashis Das, 2013. "Using Evidence to Scale Up Innovation : Insights from a Results-Based Financing Project for Health in Zambia," World Bank Publications - Reports 18684, The World Bank Group.
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    Cited by:

    1. 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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