Health Results-Based Financing Impact Evaluation 2014
Community Survey
Zimbabwe, 2011 - 2014
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Reference ID
ZWE_2014_HRBFIE-CS_v01_M
Producer(s)
Jed Friedman
Collection(s)
Metadata
Created on
Jun 26, 2023
Last modified
Jun 26, 2023
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Identification
Survey ID Number
ZWE_2014_HRBFIE-CS_v01_M
Title
Health Results-Based Financing Impact Evaluation 2014
Subtitle
Community Survey
Country/Economy
| Name | Country code |
|---|---|
| Zimbabwe | ZWE |
Study type
Other Household Survey [hh/oth]
Series Information
The Government of Zimbabwe funds its health sector at a level lower than many other Sub-Saharan African countries. As a result, a major financial burden of health care falls on households in the form of out-of-pocket payments, rendering the health system inequitable and inefficient. There is evidence that many poor households have to rely on substandard care or even forgo necessary health care due to their low capacity to pay. In response to this adverse health care scenario, and to operationalize the Results-Based Management Strategy, the Government has been implementing the RBF pilot program through the Health Sector Development Support Project since July 2011. The Government receives grant support from the Health Results Innovation Trust Fund for the RBF program. Cordaid, an international nongovernment organization, serves as a fundholder and provides technical support to the Government to execute RBF functions. The World Bank led the impact evaluation.
Abstract
The RBF pilot program has three components:
(i) results-based contracting;
(ii) management and capacity building; and
(iii) monitoring and documentation. Under the first component, a portion of financing received by health facilities depends on the quantity and quality of services, with a focus on maternal and child health.
User fees were abolished in RBF pilot program districts, with the aim of improving access to care. The impact evaluation was designed to inform several policy questions including the effects of the RBF pilot program on the utilization and quality of maternal and child health services as well as its effects on health system functioning.
The impact evaluation comprised quantitative and qualitative approaches. The evaluation investigated the impact of RBF over a broad range of targeted and non-incentivized services related to maternal and child health services.
(i) results-based contracting;
(ii) management and capacity building; and
(iii) monitoring and documentation. Under the first component, a portion of financing received by health facilities depends on the quantity and quality of services, with a focus on maternal and child health.
User fees were abolished in RBF pilot program districts, with the aim of improving access to care. The impact evaluation was designed to inform several policy questions including the effects of the RBF pilot program on the utilization and quality of maternal and child health services as well as its effects on health system functioning.
The impact evaluation comprised quantitative and qualitative approaches. The evaluation investigated the impact of RBF over a broad range of targeted and non-incentivized services related to maternal and child health services.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
- Household
- Facility
- Facility
Version
Version Description
v01. Edited, anonymized datasets for public distribution.
Scope
Notes
Zimbabwe's Health Results-Based Financing Impact Evaluation 2014, Community Survey covers the following topics:
- Health Care Coverage
- Maternal and neonatal care
- Child health and immunization
- Corollary evidence on health service
- Quality of services
- Structural quality
- Process quality
- Corollary evidence on health service utilization from administrative data
- Client satisfaction
- Health systems
- Out-of-pocket expenditures
- Task-shifting and non-incentivized activities
- Facility governance and autonomy
- Human resources: health workers' satisfaction and motivation
- Health Care Coverage
- Maternal and neonatal care
- Child health and immunization
- Corollary evidence on health service
- Quality of services
- Structural quality
- Process quality
- Corollary evidence on health service utilization from administrative data
- Client satisfaction
- Health systems
- Out-of-pocket expenditures
- Task-shifting and non-incentivized activities
- Facility governance and autonomy
- Human resources: health workers' satisfaction and motivation
Coverage
Geographic Coverage
National
Universe
Thirty-two districts serve as the total study sample for the impact evaluation, comprising the 16 districts in the RBF pilot and 16 comparators. These 32 districts were purposively sampled from the universe of 64 districts in Zimbabwe.
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| Jed Friedman | The World Bank |
Producers
| Name | Affiliation | Role |
|---|---|---|
| Ashis Das | The World Bank | Co-Principal Investigator |
| Ronald Mutasa | The World Bank | Senior Health Specialist and Task Team Leader |
Funding Agency/Sponsor
| Name | Abbreviation | Role |
|---|---|---|
| Health Results Innovation Trust Fund | HRITF | Grant support |
| Ministry of Finance and Economic Development | Co-Funding |
Other Identifications/Acknowledgments
| Name | Affiliation | Role |
|---|---|---|
| Marjolein Dieleman | Royal Tropical Institute, Amsterdam | Senior Advisor |
| Summit Kane | Royal Tropical Institute | Health Systems Advisor |
Sampling
Sampling Procedure
The process evaluation applied a retrospective study design and a theory-based evaluation approach that made use of sequential mixed methods. The retrospective design allowed for classification of observations according to the outcomes of interest and retrospectively assessing their exposure and interaction with specific study factors, e.g., contextual factors and intervention design factors. This is facilitated by the theory-based evaluation approach, which examines the interaction between the context, the actors, and the intervention, and then attempts to explain how this interaction works to produce the outcomes of the intervention by interrogating the intervention’s formal theory of change. The theory-driven approach sought to explore the influence of contextual factors on interventions and its outcomes through tracking and validating the program impact pathways.
A multistage sampling approach was used to select the Province, Districts, Facilities and Community Members with each using Purposive Sampling although each had varying “purposes” or specific reasons for selection. The cascade sampling first selected three provinces from the eight rural provinces in which RBF operated. The criteria for selection was based on geographic spread to ensure representation from each geo-region. Then within each of the three selected provinces, one or two districts were selected based on their identification as cases of interest by the project implementing entity. A total of four districts were selected.
Finally, the third stage of sampling involved the selection of one high- and one low-performing facility from each selected district. Of note is that the facilities were in part selected based on performance as defined by their actual earnings relative to expected earnings. The classification of performance therefore entailed initially assessing facility performance using quantitative methods and then proceeding to obtain primary qualitative data. The research team collected primary data through in-depth interviews, focus group discussions, and group interviews. The basic principles of analyzing qualitative data were applied. In particular, the processing of data for each facility made use of a desktop matrix analysis of themes drawn from both the conceptual framework and others emerging from transcripts. A comparison of these qualitative data across facilities enabled the research team to identify trends across facilities and to interpret the findings.
A multistage sampling approach was used to select the Province, Districts, Facilities and Community Members with each using Purposive Sampling although each had varying “purposes” or specific reasons for selection. The cascade sampling first selected three provinces from the eight rural provinces in which RBF operated. The criteria for selection was based on geographic spread to ensure representation from each geo-region. Then within each of the three selected provinces, one or two districts were selected based on their identification as cases of interest by the project implementing entity. A total of four districts were selected.
Finally, the third stage of sampling involved the selection of one high- and one low-performing facility from each selected district. Of note is that the facilities were in part selected based on performance as defined by their actual earnings relative to expected earnings. The classification of performance therefore entailed initially assessing facility performance using quantitative methods and then proceeding to obtain primary qualitative data. The research team collected primary data through in-depth interviews, focus group discussions, and group interviews. The basic principles of analyzing qualitative data were applied. In particular, the processing of data for each facility made use of a desktop matrix analysis of themes drawn from both the conceptual framework and others emerging from transcripts. A comparison of these qualitative data across facilities enabled the research team to identify trends across facilities and to interpret the findings.
Data Collection
Dates of Data Collection
| Start | End | Cycle |
|---|---|---|
| 2011-12 | 2012-02 | Baseline |
| 2014-05 | 2014-08 | Follow-up |
Data Collection Mode
Face-to-face [f2f]
Data Collectors
| Name | Abbreviation | Affiliation |
|---|---|---|
| Ministry of Health and Child Care | MOHCC | Government of Zimbabwe |
Questionnaires
Questionnaires
The "Community Questionnaire" covers the following topics:
1. Direct Observation
2. Composition of Interview
3. Demography
4. Access to basic services and community characteristics
5. Health
6. Social capital and community empowerment
7. Economic activities
8. External shocks
9. Community programs
10. Prices
11. Costs of RBF project
1. Direct Observation
2. Composition of Interview
3. Demography
4. Access to basic services and community characteristics
5. Health
6. Social capital and community empowerment
7. Economic activities
8. External shocks
9. Community programs
10. Prices
11. Costs of RBF project
Access policy
Contacts
| Name | Affiliation | |
|---|---|---|
| Jed Friedman | The World Bank | jfriedman@worldbank.org |
Citation requirements
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Example:
Jed Friedman, World Bank. Health Results-Based Financing Impact Evaluation 2014, Community Survey (HRBFIE-CS). Ref. ZWE_2014_HRBFIE-CS_v01_M. Dataset downloaded from [URL] on [date].
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Example:
Jed Friedman, World Bank. Health Results-Based Financing Impact Evaluation 2014, Community Survey (HRBFIE-CS). Ref. ZWE_2014_HRBFIE-CS_v01_M. Dataset downloaded from [URL] on [date].
Disclaimer and copyrights
Disclaimer
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Metadata production
DDI Document ID
DDI_ZWE_2014_HRBFIE-CS_v01_M
Producers
| Name | Abbreviation | Affiliation | Role |
|---|---|---|---|
| Development Economics Data Group | DECDG | The World Bank | Documentation of the DDI |
Date of Metadata Production
2021-06-18
DDI Document version
Version 1 (June 2021)