The implementation of a results-based health care financing model in Zimbabwe: Nurses’ perspectives

Abstract

Health care financing and equity remain a global challenge for both  developed and developing countries. The Results-Based Financing (RBF) model was implemented in Zimbabwe in 2014. This model is defined as a strategy that is used to link financing to predetermined results, with payment only made upon realisation of agreed-upon results that are confirmed through a meticulous verification process. The purpose of this study was to explore nurses’ perspectives regarding the implementation of RBF in Zimbabwe with the aim of recommending measures to strengthen the programme. To capture the direct experiences of nurses implementing this financing model, the study utilised a qualitative approach. Three focus group interviews were conducted, with a total of 21 nurses implementing the RBF model in Mashonaland East Province, Zimbabwe. The steps of  qualitative analysis described in Creswell (2014) were followed. Thematic analysis was used to identify common issues that recur, and these were summarised in a narrative form. Results showed that nurses reported increased motivation from the incentives built into the financing model. They also mentioned some successes realised in health care. Several challenges, such as lack of continuum of care owing to user fees charged at district hospitals, increased workload on account of overwhelming  administrative requirements of RBF and delays in subsidies  reimbursements and difficulties in accessing funds from banks due to prevailing cash shortages in the country, were highlighted and suggestions proffered to strengthen the implementation of donor funds in health care. It was concluded that nurses play a significant role in implementing health care financing reforms in Zimbabwe. Urgent attention is required to address the challenges in order to ensure the sustainability of reported gains.

Keywords: Foreign aid, nurses’ perspectives, results-based financing, Zimbabwe.