Health Results-Based Financing Impact Evaluation 2014
Other Household Survey [hh/oth]
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.
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.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
v01. Edited, anonymized datasets for public distribution.
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
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
The World Bank
The World Bank
The World Bank
Senior Health Specialist and Task Team Leader
Health Results Innovation Trust Fund
Ministry of Finance and Economic Development
Royal Tropical Institute, Amsterdam
Royal Tropical Institute
Health Systems Advisor
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.
Dates of Data Collection
Data Collection Mode
Ministry of Health and Child Care
Government of Zimbabwe
The "Community Questionnaire" covers the following topics:
1. Direct Observation
2. Composition of Interview
4. Access to basic services and community characteristics
6. Social capital and community empowerment
7. Economic activities
8. External shocks
9. Community programs
11. Costs of RBF project
The World Bank
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
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
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.