Impact evaluation of Zimbabwes health results based financing project
| ISRCTN | ISRCTN16392613 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN16392613 |
| Secondary identifying numbers | N/A |
- Submission date
- 30/10/2014
- Registration date
- 05/12/2014
- Last edited
- 25/06/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English summary of protocol
Background and study aims
This study will evaluate the impact of results based financing (RBF) on priority maternal (mother) and child health services in rural districts of Zimbabwe. RBF is an output based financing mechanism where the health providers receive financial incentives to provide a pre-agreed set of services designed to help people in poor countries to live healthier lives. The objective of the Zimbabwe RBF impact evaluation is to inform policy regarding the effectiveness of the RBF model and support the government with additional evidence for potential scale up. The primary research question is – “What is the causal effect of results based financing with suspension of user fees on priority population health utilization and outcome measures in intervention districts?”
Who can participate?
Participating health facilities come from the selected 16 rural districts for implementation of RBF.
What does the study involve?
The government has selected 16 districts to implement RBF with two in each rural province of the country. All health facilities in these 16 districts will receive RBF incentives every 3 months based on a set of indicators related to maternal and child health. The facilities receive incentives on quantity (volume of services), quality (adherence to national standards of care), and client satisfaction. All participating health facilities receive RBF resources according to their level of service provision (primary, secondary or hybrid, i.e. primary plus secondary) and remoteness. The comparison districts have been selected within each province with pair-matching on geographical accessibility (i.e. rural and remoteness), type and level of health facilities, average facility catchment population, proportion of staff in position, presence of key staff such as the District Medical Officer, health services utilization rates such as antenatal care coverage, postnatal care coverage, institutional delivery and immunization
rates. The facilities in comparison districts will not receive any RBF incentives (business-as-usual).
What are the possible benefits and risks of participating?
The health facilities will benefit from the financial resources tied with performance. There are no side effects or risks of this intervention.
Where is the study run from?
There are 356 health facilities from 16 rural districts participating in this study. The implementing agency is the Ministry of Health and Child Care, Zimbabwe.
When is study starting and how long is it expected to run for?
March 2012 to March 2015.
Who is funding the study?
Governments of Norway and the UK through the Health Results Innovation Trust Fund administered by the World Bank
Who is the main contact?
Ashis Das
adas8@worldbank.org
Contact information
Scientific
The World Bank
1818 H Street NW
Washington, D.C.
20433
United States of America
Study information
| Study design | Controlled before and after study; quasi-experimental study |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Other |
| Study type | Quality of life |
| Scientific title | The effects of results based financing on maternal and child health access and utilization in rural Zimbabwe: Impact Evaluation of Zimbabwes Health Results Based Financing Project |
| Study acronym | Zimbabwe RBF IE |
| Study objectives | Results based financing increases access to and utilization of maternal and child health services in rural Zimbabwe |
| Ethics approval(s) | Medical Research Council of Zimbabwe, 29/11/2011, ref. MRCZ/A/1648 |
| Health condition(s) or problem(s) studied | Maternal and child health |
| Intervention | Health facilities within RBF districts will receive incentives every quarter based on attaining 1. Quantity (volume of services) 2. Quality (adherence to national standards of care) 3. Client satisfaction Health facilities in the control districts receive no incentives (business-as-usual). |
| Intervention type | Other |
| Primary outcome measure | Health utilization indicators: 1. Antenatal care 2. Institutional delivery 3. Postnatal care 4. Immunization 5. Outpatient consultations 6. Referral 7. Adoption of family planning methods 8. ARV prophylaxis Household level indicators: 1. Household health seeking behavior 2. Out-of-pocket healthcare expenditure 3. Satisfaction on the service provider These will be measured through a household survey at the end of the intervention |
| Secondary outcome measures | Health facility infrastructure indicators: 1. Drug stockout rates 2. Availability of drugs 3. Availability of clinical protocols 4. Availability of equipment 5. Updated records Quality of care indicators: 1. Counseling and client interaction 2. Waiting time 3. Physical examination Equity indicators: 1. Utilization of health care and quality of care indicators vis-à-vis clients' socio-economic and residence status Health worker indicators: 1. Health worker training status 2. Knowledge 3. Motivation 4. Job satisfaction These will be measured through a health facility survey at the end of the intervention |
| Overall study start date | 01/03/2012 |
| Completion date | 01/03/2015 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Other |
| Sex | Both |
| Target number of participants | All health facilities in participating rural districts (n=356) |
| Key inclusion criteria | 1. Health facilities within the selected 16 rural districts and matched control districts 2. Health facilities contracted under RBF project |
| Key exclusion criteria | 1. Health facilities outside the selected 32 rural districts 2. Health facilities not contracted under RBF project |
| Date of first enrolment | 01/03/2012 |
| Date of final enrolment | 01/03/2015 |
Locations
Countries of recruitment
- United States of America
- Zimbabwe
Study participating centre
20433
United States of America
Sponsor information
Government
The World Bank
1818 H St NW
Washington, DC
20433
United States of America
"ROR" |
https://ror.org/00ae7jd04 |
|---|
Funders
Funder type
Government
No information available
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not provided at time of registration |
| Publication and dissemination plan | Not provided at time of registration 2017 thesis in https://doi.org/10.17037/PUBS.04539376 (added 25/06/2020) |
| IPD sharing plan |
Editorial Notes
25/06/2020: Link to thesis added to publication and dissemination plan.
