Analysis of social investment in health systems reform: a case study of results-based financing in Marondera District, Zimbabwe.

IF 0.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Pan African Medical Journal Pub Date : 2024-09-02 eCollection Date: 2024-01-01 DOI:10.11604/pamj.2024.49.4.43943
Prosper Nyabani, Bhekinkosi Moyo, Keratiloe Sishoma Mogotsi
{"title":"Analysis of social investment in health systems reform: a case study of results-based financing in Marondera District, Zimbabwe.","authors":"Prosper Nyabani, Bhekinkosi Moyo, Keratiloe Sishoma Mogotsi","doi":"10.11604/pamj.2024.49.4.43943","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored.</p><p><strong>Methods: </strong>the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software.</p><p><strong>Results: </strong>improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. <b>Conclusion:</b> reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.</p>","PeriodicalId":48190,"journal":{"name":"Pan African Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.9000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453109/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pan African Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11604/pamj.2024.49.4.43943","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored.

Methods: the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software.

Results: improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.

卫生系统改革中的社会投资分析:津巴布韦马龙德拉区基于成果的融资案例研究。
导言:大多数发展中国家普遍存在捐助资金使用不当和卫生系统绩效不佳的问题;为解决这一问题,开发了基于成果的筹资(RBF)模式。然而,当务之急是探索基于结果的融资对卫生系统绩效的具体影响。因此,本研究试图探讨成果制筹资对卫生工作者的积极性和管理、时间视角、分配原则和政策连贯性的影响。方法:本研究采用了定性、探索性、描述性和现象学设计,使用面对面半结构化访谈录音,从剩余的和可用的两名卫生筹资专家、两名技术伙伴组织代表和六名卫生工作者那里捕捉不同的视角,他们从 2011 年到 2022 年一直在津巴布韦马龙德拉地区实施基于结果的筹资。结果表明:尽管存在一些挑战,包括人员不足、工作量增加、采购繁文缛节、财务僵化、补贴支付延迟等,这些都侵蚀了提高绩效的成果,但成果制融资提高了员工的积极性,改善了治理、卫生系统发展、公平性和政策一致性。此外,还观察到由于贫困人口在较高医疗水平上面临使用费问题而导致医疗服务缺乏连续性,以及捐助者和医疗机构工作人员之间的参与有限。结论:加强已明确指出的积极因素对于保持已实现的保健成果至关重要;然而,需要紧急关注应对挑战,以保护迄今取得的阶段性成果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Pan African Medical Journal
Pan African Medical Journal PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
1.80
自引率
0.00%
发文量
691
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信