An innovative funding model is helping Zimbabwe’s rural health centres deal with the outbreak of COVID-19 and continuity of essential health services through flexible and performance based procurement and service provision.
The Health Development Fund – Results Based Financing Programme (HDF-RBF) seeks to improve the availability, accessibility, and quality of primary health services with a focus on key reproductive and child health services. The HDF-RBF programme is supporting 42 districts and was set up by the government and partners in the Health Development Fund (HDF) including European Union (EU), UK-Aid, The Swedish International Development Cooperation Agency (SIDA), the Vaccine Alliance (GAVI) and Irish-Aid.
From Mberengwa district in the Midlands to Matobo district in Matabeleland South, health authorities say the HDF-RBF has made their work easier, especially during the COVID-19 pandemic.
Activities under the HDF – RBF include the payment of RBF subsidies to a total of 966 rural health facilities, 67 hospitals, 42 district health executives (DHEs) and 8 provincial health executives (PHEs), building the capacity of the Ministry of Health and Child Care staff to manage the RBF programme to institutionalise the programme within the Ministry, carrying out field visits to verify utilisation of the subsidies, assisting facilities to improve their internal control systems and providing guidance on how facilities can improve earnings.
At Mberengwa District Hospital, the funds have been used to buy fuel for vehicles to conduct district outreach, repair vehicles and motorbikes, renovation of hospital wards and other premises, procurement of medicines and sundries, stationery, equipment such as thermometers and scales, furniture, food for admitted patients and a 25% incentive that has contributed to staff motivation.
Wanezi Health Centre and Jeka Rural Hospital, also in Mberengwa District, used the HDF-RBF resources to buy medicines and sundries, stationery, equipment such as thermometers and scales, furniture and to support pregnant women at waiting mothers homes through provision of food and toiletries.
In Matobo District in Matabeleland South, Maphisa District Hospital, HDF-RBF assistance was used to support programmes to promote maternal health, child health and nutrition, procurement of equipment, medicines and consumables.
The hospital also used the money to repair and maintain the maternity ward, support community involvement in hospital affairs through health centre communities, pushing demand for use of services and village health worker (VHW) involvement in growth monitoring and referral of the hospital as part of demand creation, among other things.
“RBF is a performance-based system of financing health operations through rewarding health facilities by paying an agreed amount of money per every service offered and also paying quality bonuses as determined by the level of quality of service as determined by a checklist that is used to measure the level of quality,” said Kwanele Nsingo, a Health Field Officer for Crown Agents in Matobo District.
Crown Agents are a purchasing agent providing technical support in the implementation of the HDF-RBF programme. They also support with the training and capacity building to government to manage the RBF.
“In general, the more the number of clients that a health facility serves and the higher the quality of service the health facility offers, the more the money the health facility realises,” he added.
Nsingo believes the importance of the HDF-RBF became even more pronounced during the ongoing outbreak of COVID-19 as it enabled health facilities to conduct outreach programmes to encourage preventative health behaviours in the communities.
Paul Musona, the Mberengwa Environmental Health Officer, said the HDF-RBF came in handy when health facilities in the district urgently needed incinerators for proper disposal of waste at the onset of the COVID-19 outbreak.
“It helped us a lot,” Musona said. “Initially clinics or health institutions used their funds to construct incinerators or waste disposal sites. Through the RBF we were able to construct a new incinerator, procure PPE for 36 institutions and also had assistance for logistical use such as fuel for community outreach,” he said.
At Mberengwa District Hospital RBF resources are also being utilised to put finishing touches to a labour ward.
Mberengwa District Nursing Officer Mavis Munengiwa said the HDF-RBF was playing a major role in curbing maternal deaths and child mortality in the district.
“HDF-RBF played an important part, some institutions managed to renovate their maternity waiting homes, which also brought some comfort to the mothers in waiting homes,” Munengiwa said.
“The procuring of personal protective equipment (PPE) also played an important role in training our health workers. This assisted our health workers to be very confident in the management of all the cases during this COVID-19 pandemic.”
“We also managed to procure major resources for maternal and child health services and very important medicines used in labour wards, hence all our mothers were well managed during labour and delivery by confident and well protected health workers.”
Amos Mareverwa, a provincial health field officer in the Midlands Province for Crown Agents, said the HDF-RBF had helped to revamp infrastructure at rural health centres including improved record keeping for medical reports.
“In the Midlands Province we are covering five districts namely Mberengwa, Shurugwi, Kwekwe, Gokwe North and Chirumhanzu where there are primary health facilities and hospitals,” Mareverwa said.
“For the contracted health facilities, we have 114 primary health care facilities and 13 hospitals under the HDF-RBF programme.”
Mareverwa attributed the success of the RBF programmes to active involvement by communities.
He said the fact the community leaders came up with projects that required funding meant that they had an active interest in their implementation, including providing labour. – Unicef Zimbabwe