This presentation was given at the 2nd Global Symposium on Health Systems Research in Beijing, China, November 1, 2012 during the session "Approaches to Embedding Research in Action".
Results-based approaches are increasing being used in developing countries to strengthen health systems and to improve health service delivery. Zambia is currently implementing an RBF project designed to catalyze the country’s efforts to reduce maternal and child mortality in ten pilot districts through supply-side interventions. Before the pilot phase, a pre-pilot was implemented over a period of 18 months in Katete District to improve the operational design of the pilot. We present the findings from Katete pre-pilot and the implication of the results on policy and planning.
A mixed-methods approach was used to review the information systems, project documents, and financial audit reports. Focus groups and in-depth interviews were organized among the health managers, health providers, and beneficiaries.
The additional operational income earned by the health facilities through RBF improved staff motivation and productivity. It further provided the opportunity for innovations such as local hiring of staff to fill in human resource gaps, procurement of minor equipment and commodities as well as demand-side incentives to boost service utilization. There was a notable increase in the utilization of services for key health interventions ranging from 6% to 54% between 2009 and 2010. Quality of data recording and reporting improved. Furthermore, managerial autonomy of the health facilities and community participation in decision-making were enhanced.
The Katete pre-pilot has been an important piece to the RBF project in Zambia. It provided an opportunity to test and refine the model in a real setting with an evidence base. The lessons learnt from the pre-pilot stimulated policy dialogue on RBF among the MOH and its partners, and further prompted the revision of the design before the pilot phase.