Technical Support for Zimbabwe Health Results-Based Financing Program and National Quality Policy Framework

Overview and Objectives

The World Bank has been implementing the Health Results Innovation Trust Fund (HRITF) in Zimbabwe since 2008. The fund’s objective is to design and implement sustainable, results-based financing (RBF) programs to improve the quality of health care and health outcomes. The HRITF is financing RBF pilot interventions—both supply-side (e.g., provider payment schemes, contracting out) and demand-side (e.g., vouchers)—especially for the most vulnerable populations. The expectation is that this mechanism can be used to increase access to appropriate, high-quality health care and encourage individuals to adopt behaviors that will improve their health.

Evidence gathered to date indicates that the RBF initiative has been successful in improving service utilization and the quality of certain maternal and child health services; however, the project’s mid-term review concluded that the quality of care component was less operationalized than the quantity (units of service delivery) component. Thus, the MOHCW, the World Bank, and other stakeholders agreed to several improvements to strengthen the quality of care component. Proposed improvements, to be implemented during the second phase of the RBF program, include developing a quality improvement framework and incorporating quality of care and quality improvement activity measures. These changes will likely strengthen the quality of care in health facilities and indicate progress.

URC is providing technical support to 1) strengthen the existing quality of care policy framework and 2) develop a strategic plan to support implementation of that framework. As a complementary activity, we are also providing technical support for the development of a new set of quality of care score cards to support the introduction of financial incentives for clinical quality of care and quality improvement activity measures.

• Helping to revise the MOHCW quality of care policy,
• Contributing to the development of a strategic plan for policy implementation in collaboration with MOHSW and stakeholders,
• Developing a framework for quality improvement as part of the RBF program,
• Developing quality of care checklists (focused on clinical quality and quality improvement activity measures) for use in health centers and hospitals, and
• Developing a “how to manual” and training on the use of the quality of care checklists in the RBF program.

Design and implement sustainable, results-based financing (RBF) programs to improve the quality of health care and health outcomes. The HRITF is financing RBF pilot interventions, especially for the most vulnerable populations. The expectation is that this mechanism can be used to increase access to appropriate, high-quality health care and encourage individuals to adopt behaviors that will improve their health.