Several developing countries face the challenge of attaining sufficient population-level impact to meet health-related Millennium Development Goals (MDGs) 1c, 4, 5, and 6. 1 This situation is partly attributable to constraints in their health systems, including: severe shortages in human resources for health; inequalities in service provision and utilization; limited financial resources; and inefficiencies in resource allocation and use. Even in countries with adequate financial resources, health indicators are sometimes poor due to inefficiencies and a lack of performance-related initiatives.
In an attempt to strengthen health systems and improve health-service delivery, several countries in Africa are increasingly using results-based financing (RBF) approaches in their health programs. The premise is that linking financing to results will lead to improvements in health systems and health-outcome indicators. This SmartLesson captures emerging lessons from Zambia’s drive to improve service delivery in the public-health sector with support from the World Bank’s RBF initiative.
Lessons learned highlighted in this paper:
1. Pre-piloting is a useful approach to embedding evidence into policy and planning.
2. In designing an RBF approach primarily executed by the public sector, key elements such as the separation of different functions needs to be thought through carefully, which may result in the model taking longer to develop and implement.
3. Investment in capacity and regular dissemination of results are useful in enhancing ownership and promoting sustainability.
4. RBF can increase flexibility in health facility management, encourage innovation and creativity, and improve accountability in service delivery.
5. Impact evaluations should be designed early and contextualized to the country setting.