In every Results-Based Financing (RBF) workshop, my role has always been behind the scenes and one of the highlights of every workshop is to experience the “frontline” and learn how RBF programs help communities. Having the opportunity to experience this in Turkey, Argentina, Kenya and now Zimbabwe, gives me a better perspective of how RBF evolved.
Among the site visits we were able to experience in Zimbabwe were the Marondera District Hospital – a secondary level hospital - and the “Lastly” Clinic – both contracted through Results-Based Financing since May 2011. We were greeted with much singing and dancing, creating a whirlwind of excitement. And, the willingness of all to share - from beneficiaries to healthcare workers to local authorities – was most helpful in highlighting major RBF successes.
For me, this visit showed that RBF can boost progress: it helped people access care; it helped improve the quality of care by providing essential drugs and equipment and by refocusing attention on clinical protocols and motivating personnel. I was impressed by the delivery, maternity and neonatal wards: they were filled with patients and health care providers; medical equipment was available; and, medical supplies seemed to be sufficient. To me, this shows that RBF can help the health system come full circle: it creates a better environment for care, ensures that patients are healthy and satisfied, that providers are motivated and that communities and health facilities work together.
Things are, of course, not perfect. Sustainability – and resource availability – remains a concern for beneficiaries, community health committees and healthcare providers alike. Long distances are also a problem, particularly for emergency care – including complicated deliveries. Although there are more ambulances, in the event of an emergency, ambulances have to cover long distances to go pick up patients and transport them back to the district hospital. This can create extreme delays, losing valuable time for patient care.
As I look back, what did I learn from this visit? I have learned that RBF – although it differs in each country – can work, provided that learning and adaptation are both continuous and constant. It has also reaffirmed my belief in the potential of RBF to change health systems and ensure better care for communities.
This visit would not have been successful without the support of the Ministry of Health of Zimbabwe and Cordaid.