Zimbabwe is implementing a Result Based Financing program since 2011, which was designed to improve utilization of maternal and child health services offered by public health facilities. Four years after the program inception, reports of low vitamin A coverage and, high home deliveries are common. The study seeks to understand why there is still low uptake of maternal and child health services. Using cases of Mazowe district health facility catchments, community dialogues were employed to explore underlying causalities to low maternal and childhood health services uptake.

This article examines the effects of several RBF programs on health care purchasing functions in three fragile and post-conflict settings: Uganda, Zimbabwe and the Democratic Republic of Congo (DRC) over the past decade.

This paper presents findings from a study which sought to understand why health workers in the results-based financing (RBF) arrangements in Zimbabwe reported being satisfied with the improvements in working conditions and compensation, but paradoxically reported lower motivation levels compared to those not working under RBF arrangements.

This report reviews the comprehensive impact evaluation of the RBF pilot program implemented in Zimbabwe, officially known as the Health Sector Development Support Project. It seeks to present and analyze the impact evaluation results of the RBF pilot program that supports the Ministry of Health and Child Care (MOHCC) in its efforts to increase the availability, accessibility, and utilization of quality health care to improve maternal, neonatal, and child health.

Training, motivating and retaining human resources is crucial for the improvement of health outcomes, especially in low and middle-income countries (LMICs) where human resources availability and management have been recognized as one of the key health system’s barriers to the achievement of the Millennium Development Goals. In recognition of the limitations of current financial incentives and/or remuneration levels, Performance-Based Financing (PBF) mechanisms have been introduced in many LMICs in recent years.

Provider incentives are targeted to improve health worker outcomes, yet the evidence captures their effect more in terms of utilization of services (and quality of care to some extent). This paper assesses the impact of a Results-based Financing (RBF) program in Zimbabwe on health worker satisfaction and motivation. It also tries to underpin the causal pathways of these observed outcomes. Health workers in RBF facilities had higher overall job satisfaction, particularly for compensation (8.436 points, on a maximum scale of 100; p<0.05).

Dr. Tafadzwa Goverwa – Provincial Medical Director at the Ministry of Health and Child Care in Zimbabwe – provides an example of how ITC can be used to improve the measurement and payment of Quality of Care. 


Le projet de FBR du Zimbabwe se repose sur trois composantes : 1) les contrats basés sur les résultats ; 2) la gestion et le renforcement des capacités ; 3) le suivi et la documentation. Ce projet prévoit d’améliorer les services de santé de manière significative – particulièrement ceux liés a la santé maternelle et infantile –à la fois du côté de l’offre et du côté de la demande afin de contribuer à une réduction de la mortalité et de la morbidité maternelles et infantiles.

Résumé de Rapport


The RBF project in Zimbabwe 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.

Report Summary

Results-Based Financing has become widely known among people across Zimbabwe. Despite the challenging setting, this approach has quickly contributed to better health services.

The program, which is funded by the World Bank’s multi-donor Health Results Innovation Trust Fund at the request of the government, provides subsidies to health clinics and hospitals based on their performance in delivering a package of free health services to pregnant women and children under five.

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