Introduction
This report presents the second cycle of the process monitoring and evaluation (PME) for the Results-Based Financing (RBF) project in Zimbabwe, formally the Health Sector Development Support (HSDS) Project. The study’s findings demonstrate the linkages between the first and second PME evaluations. The study prioritizes performance of incentivized indicators, quality of care (QoC) and expenditure/payment data aspects of the health system and program.
The overarching goal of the PME study is to help the Ministries of Health and Child Care (MOHCC) and Finance and Economic Development (MOFED), Cordaid, the World Bank Task Team and interested local and international stakeholders learn from the RBF project; make mid-course adjustment to the technical design and operational processes; and enhance evidence-based project management decision making. Given that quantitative performance of health facilities is monitored every quarter, the study seeks to go beyond the quantitative performance trends to better understand qualitative factors at district, health facility, health worker and community levels that explain performance under the RBF project. This PME is an exploration of the causal pathways from implementation to results. It is a study of the links between activities, outcomes and context of the RBF project. In a way, the study unravels the “black-box” of implementation of performance-based financing interventions in a bid to deepen knowledge of the RBF intervention in Zimbabwe and how reality links with the original design and theoretical assumptions with which the Government, Cordaid and the Bank worked when the intervention was conceptualized.
The RBF project design is anchored on three components: 1) results-based contracts, 2) management and capacity building, and 3) monitoring and documentation. It is anticipated that through this project, both supply and demand for health services— particularly maternal and child health—will be significantly improved, contributing to a reduction in maternal and child mortality and morbidity. The project’s monitoring and evaluation activities are currently tracking the performance of incentivized indicators, QoC and expenditure/payment data. While this ongoing analysis has provided very useful insight into the performance of the project to date, it is essential to go beyond the numbers and explore the underlying processes and dynamics in the trajectory of change. For example to fully understand variation in performance by facility or district it was essential to explore non-quantitative factors in order to deepen knowledge of RBF so as to improve outcomes further; enhance it for sustainability and future application and adapt to other contexts. See Annex 1 Project Design Summary.