RESULTS-BASED FINANCING - Crown Agents
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RESULTS-BASED FINANCING
Strengthening the Health Delivery System in Zimbabwe
June 2018
RBF
THE RBF PROGRAMME IS
FOREWORD /
BEING IMPLEMENTED IN
SINCE 2012,
MATERNITY
WAITING HOMES
42 RURAL DISTRICTS
835
HAVE HELPED CUT DOWN RURAL HEALTH FACILITIES
COVERING A TOTAL OF
MATERNAL The Ministry of Health and Child maternity Waiting homes, and procurement
DEATHS IT SERVES Care (MOHCC) runs under the mission of medicines and sundries amongst other
BY AT LEAST statement: “to provide, administer, things. This is not to mention that support
AN ESTIMATED
50%. 67 6,6 MILLION coordinate, promote and advocate for that is going to paying allowances to health
HOSPITALS ACROSS the provision of equitable, appropriate, staf in order to keep their morale high
THE COUNTRY PEOPLE
accessible, afordable and acceptable and improve their attitudes and quality
quality health services and care to of service. Since 2012, in these districts
Zimbabweans while maximizing the use of we have seen maternal deaths being cut
available resources, in line with the primary down by at least 50 percent because of
health care approach”. We believe that this the intervention of building the maternity
is a mission that is critical to a Zimbabwe waiting homes alone.
where every citizen enjoys their inalienable
right to health. If this right is denied, the These developments are not only in
right to life itself, seen by many as the most line with the government’s Zimbabwe
162 556 2 485 519 902 important right, is denied. This centrality Agenda for Sustainable Socio-Economic
NUMBER OF WOMEN NUMBER OF CHILDREN NUMBER OF FACILITIES of the right to health makes our mission Transformation (ZIMASSET) blueprint but
ACCESSING ANC4+ ATTENDING GROWTH TRAINED IN DATA a critical one. But that does not make it are a great stride to our commitment,
IN 2017 MONITORING IN 2017 MANAGEMENT an easy one; there is infrastructure to be among other nations, to fulfil the
expanded and developed, health staf to be Sustainable Development Goals (SDGs).
trained and deployed, medicines that need We continue to cherish and nurture
to be supplied as well as communities to be partnerships that help us reach these goals.
mobilized for health services provision and Here, in this publication, you will have an
?! access. To achieve this, we need partners.
This is why we are grateful for the support
opportunity to hear the real life stories of
the impact of our partners’ interventions
we receive through Crown Agents under on people and their communities. As a
the RBF programme. ministry we are proud to be helping create
these stories of impact.
337 2% Through RBF, a number of health facilities
NUMBER OF NURSES THE NATIONAL DATA
in several districts have managed to
IN 5 DISTRICTS OF ERROR RATE; DECLINED
MASHONALAND WEST FROM 56% BEFORE RBF
refurbish their infrastructure e.g. repairing Major General (Dr) G. Gwinji
PROVINCE TRAINED IN and painting their premises and building of Secretary for Health and Child Care
MIDWIFERY
3
RBF
RBF RBF
WHAT’S IN THIS ISSUE?
Foreword 3
News: Public-Private Partnership Bears Innovation 6
Contributors 8
From the Editor 9
About the Publication 10
CHAPTER ONE 12
Understanding RBF Impact: The Background 13
What is the Results-Based in Health Financing Strategy? 13
The RBF Impact Synopsis 16
CHAPTER TWO 18
RBF Strengthening Health Delivery Systems 18
RBF Improves Data Management in Health Facilities 19
MoHCC Lauds RBF Role in Improving Data Quality 24
Quality Assessments: RBF beyond the Numbers 24
Improved Quality Increases Earnings 27
Bangure Clinic: The Impact of QAs on Service Delivery 29
Money Well-Managed is Lives Saved: RBF Helps Improve Financial
Management Practices in Health Facilities 31
Electronic Platforms Introduce Ease of Transaction 31
CHAPTER THREE 35
RBF Impact in Perspective 35
Improved Earnings: Rewards for Producing Results 35
Masvingo Province Leads in RBF Earnings 35
Team Work: How Masvingo Province Got it Right 37
The Story of Mushaviri Clinic 38
Nyahode Clinic Shines, thanks to the RBF Verification Process 39
Overview of the Impact of RBF on the Key Focus HDF Indicators 39
CHAPTER FOUR 42
Crown Agents Eager to Deliver 42
Technology and Innovation for Health Systems through RBF 42
Crown Agents takes RBF to Second Level Hospitals: Rolls out Training 44
Highlights: Pictures from Hospitals RBF Training 45
4 5
4 5
RBF RBF
of the apps was proud of the novelty of many challenges – incentives are keeping
NEWS the idea of adopting technology and its staf motivated to work towards achieving
potential to transform and strengthen key health outcomes, especially regarding
the implementation of RBF in Zimbabwe. maternal and child health,’ explained Dr.
PUBLIC-PRIVATE PARTNERSHIP ‘The development of these applications Mudyiradima.
BEARS INNOVATION / witnessed the technical involvement and
guidance of various MoHCC departments He went further to say that the ‘innovation
CROWN AGENTS AND THE MINISTRY OF HEALTH AND CHILD CARE such as the Health Management is embedding technology at the heart of
DEVELOPS APPS TO IMPROVE HEALTH SERVICES DELIVERY Information Systems (HMIS) Department; the Results-Based Financing programme
the Quality Department; the Nursing which accelerates health outcomes leading
Directorate; the Finance Department as to the improving of deficiencies in the
The Results-Based Financing (RBF) for well as the Information Communication system around management, use of staf
Health program has demonstrated the Technology (ICT) Department. The time, value for money and use of data for
immense potential that Public-Private support received through adoption of the decision making.’
Partnerships have in strengthening the applications across the country reflects the
country’s health delivery system and importance of these apps. Thanks to the Dr. Mudyiradima hailed the partnership
its resultant maternal and child health Ministry’s partnership with Crown Agents, between the MoHCC and Crown Agents. ‘We
care outcomes. One such development the m-IC app is now being used by 80% of value our partners in pursuit of our vision
is the Crown Agents-Ministry of Health the primary health facilities in Zimbabwe for the highest possible level of health
and Child Care (MoHCC) partnership serving a total of 6.6 million people. The and quality of life for all Zimbabweans,’
whose successes, among others, is using results of the mobile app innovation have he said before adding that the ‘technology
technology to improve health programmes been immediate and significant. provides opportunities for eficiency and
implementation, as demonstrated by the Dr. Robert Mudyiradima
Principal Director for Policy, Planning ease of doing business,’ reiterating the new
development and recent launch of the and Monitoring and Evaluation “Before the introduction of the m-IC dispensation’s well-received motto that
Mobile Incentive Calculator (m-IC) and app, some health workers were receiving ‘Zimbabwe is open for business.’
Mobile Client Satisfaction Survey (m-CSS) their incentives with delay, because the
Applications (Apps). at the health facility level - the calculation accountant was overwhelmed with data The innovations, as Dr. Mudyiradima said
of staf incentives for health personnel from clinics around the region. Now the during the launch of the apps, will help
Speaking at the launch and handover of the in the case of the m-IC and the collection app does the calculations automatically sustain the RBF program. ‘Let me thank
applications to the MoHCC, Crown Agents of patients’ feedback for m-CSS. These thereby reducing the likelihood of human the Crown Agents for their enormous
Director, Ms. Muchaneta Mwonzora said innovations came ater the two actors error. The staf is now able to receive contribution in the implementation of the
the applications were ‘a locally produced noticed inordinate delays in the calculation their dues in just two days ater the data RBF program in the 42 districts and the
solution to challenges witnessed in the and payment of RBF subsidies to health is submitted. On the other hand, the institutionalisation of the program in the
process of implementing the RBF program,’ facilities and its resulting staf incentives mobile Client Satisfaction Survey app Ministry. The tools you handover today will
adding that the initiative was ‘a result of a as well as the lack of timely client feedback is helping facilities determine needs of go a long way in supporting the Ministry to
public-private partnership between Crown on whether health facilities’ services are their clients in order to meet these and institutionalise RBF and to eventually take
Agents and the Ministry of Health.’ meeting the needs of their clients. improve health outcomes. The payment of over the program in all the districts.’
mobile incentives under the RBF for Health
The two android-based and user-friendly Dr. Robert Mudyiradima, the Principal program, and particularly the timely Following the launch, the apps are in the
mobile apps were innovated through the Director for Policy, Planning and Monitoring payment as a result of the m-IC is a boon to process of being rolled out to all districts
Crown Agents-MoHCC partnership in order and Evaluation in the MoHCC who initiated the country’s health sector that has faced across the country.
to ofer convenience in service provision and supported the designing and roll out
6 7
RBF RBF
CONTRIBUTORS / FROM THE EDITOR /
Health services consumers are oten unaware
that the services they enjoy through health
facilities are a product of many functions of the
so-called ‘health delivery system.’ All they know
is the consumer-end infrastructure, personnel implementing the RBF Programme, there are
and supplies – give them a clinic building, noticeable changes in the system - changes
some medicines as well as a health worker and worth celebrating. Such changes show that
they are happy. Do they know that there is a RBF is building resilience in the health delivery
system consisting of processes and procedures system.
Nakita De Barros
deliberately designed to deliver such services.
Theresa Mundete Probably not! Through RBF, as you shall read in this edition,
ASSISTANT EDITOR
the quality of data collected, analysed and
However, no one should fault communities reported to support health delivery at many
for not understanding the complexities of this levels has improved. For example, the story
system; there are just too many moving parts RBF Improves Data Management in Health
to this machinery. Not many would care to Facilities shares how the eforts of Crown
explain how this system works and why it is Agents and HDF partners have improved the
important. As Crown Agents, through our RBF quality of data from a data error rate of about
Programme, we realise that communities are not 50 percent in 2014 to an average of 2 percent by
just helpless patients seeking medical attention. end of 2017. We have also invested in building
They are active citizens who can help build and the capacity of health facilities and players
Taurayi Malunga Shungurudza Mudereri support such systems. That is why community in the health delivery systems to improve the
participation is more than just a buzz word in the management of financial resources. Read the
RBF Programme, it is a culture. story Money Well-Managed is Lives Saved:
RBF Helps Improve Financial Management
To such an extent that communities are key Practices in Health Facilities and aterwards,
stakeholders in the strengthening of health you will be agreeing with us that we need to
delivery systems, we submit this edition of build the capacity of the system to eficiently
our bi-annual publication with a format and manage the limited resources we have; it could
language that makes it accessible to them as be the diference between life and death as it
it is to all other stakeholders. Our common stretches the dollar we have. There are other
message throughout the publication is simple stories in this edition that give testimony to
Caroline Mubaira Anthony Sibanda yet important: investing in health for better the contributions of the RBF Programme to the
outcomes requires models that recognise the health sector. Whether it is to strengthen the
importance of investing in the system as a whole. health system itself or improving maternal and
newborn health outcomes, at Crown Agents we
Dear reader, our health system has sufered are proud of being a part of the RBF initiative.
under the economic hardships the country has Crown Agents would not have achieved this
experienced. As a result, many functions of the impact on its own. We are grateful to all the HDF
health system were compromised, the reason donors, the Ministry of Health and Child Care
why sometimes clients would walk into a facility and UNICEF for their unwavering support to the
and leave disappointed; without accessing programme.
the help they needed. The RBF Programme
Tafadzwa Mutete Terrance Mlauzi is intervening to strengthen the system and Until the next edition, stay healthy!
ensure that the system can deliver again. Over
the past year, and indeed many more years Marie-Jeanne Ofosse
8 that Crown Agents and its partners have been 9 The Editor
RBF
RBF RBF
ABOUT THE PUBLICATION /
Millions in public funds are being mobilised This is the second edition of a periodical
and channelled to development aid every publication. The first edition was titled:
year. The pursuit for results and the need Results-Based Financing: The Story
to demonstrate that, indeed, project of Hope and Caring in Zimbabwe. The
interventions are achieving results has second edition, Results-Based Financing:
given birth to results frameworks and tools Strengthening the Health Delivery System in
of a diverse nature. Understandably so, Zimbabwe, continues from where the first
development organizations are obligated to one let in celebrating in a human way, the SINCE ITS INTRODUCTION, THE RBF
illustrate that resources are being put to good change attained through the RBF in health PROGRAMME HAS NOT ONLY HELPED IMPROVE
use. However, this has made development programme. Oten expressed in technical PUBLIC HEALTH DELIVERY INFRASTRUCTURE,
work too technical and scientific to an terms in reports and project documents, the IT HAS ALSO RAISED STAFF MORALE AND, AS A
ordinary person who may want to track purpose of this series of publications is to RESULT, HELPED SHAPE COMMENDABLE HEALTH
progress of development interventions. simplify and tell the real life stories of how the OUTCOMES IN LINE WITH THE NATIONAL AS
Reports based on log frames may not tell RBF Programme is creating impact for health WELL AS GLOBAL FRAMEWORKS FOR HEALTH
the full story; the human face of the impact facilities and communities alike. DEVELOPMENT.
created by the work is sometimes lost and
people become data and statistics. Someone
has to tell the story and tell it diferently. This
is why this publication was conceived.
10 11
RBF RBF
Against this background, for Zimbabwe,
CHAPTER ONE / the RBF programme is more than just a
health financing model; rather it became
an antidote to a failing health system.
Since its introduction, the RBF Programme
Introduction / has not only helped improve public health
delivery infrastructure, it has also raised
Health financing models have evolved over
time as players in the sector seek efective
THE RBF PROGRAMME IS staf morale and, as a result, helped shape 162 556
BEING IMPLEMENTED IN commendable health outcomes in line with NUMBER OF WOMEN
ways of strengthening public health the national as well as global frameworks ACCESSING ANC4+
delivery systems and ensure equitable for health development. This publication IN 2017
access to quality health services for all. brings to the fore some of these stories
The Results-Based Financing (RBF) in of impact that came through the RBF
health, currently in use in Zimbabwe and 42 RURAL DISTRICTS programme implemented by Crown Agents
other developing countries has shown COVERING A TOTAL OF and the MoHCC.
immense potential to develop the health
sector and improve access to health 1.1 Understanding RBF Impact:
services for marginalised communities. The Background /
In Zimbabwe, with the support of the 835 2 485 519
Health Development Fund (HDF), Crown RURAL HEALTH FACILITIES The RBF Programme is a key intervention NUMBER OF CHILDREN
Agents has been implementing the RBF of the HDF hence central to the attainment ATTENDING GROWTH
programme in partnership with the of the goals of the coordinated funding MONITORING IN 2017
Ministry of Health and Child Care (MoHCC). mechanism, especially meeting the
67 targets for maternal and newborn health
The RBF Programme is being implemented HOSPITALS ACROSS THE COUNTRY targets. However, to understand how this (UHC). As a model, RBF in health rewards
in 42 rural districts covering a total of 835 impact is being realised, it is important to health facilities based on their performance
rural health facilities and 67 hospitals IT SERVES understand what RBF is and how it works. and achievements.
across the country. It serves an estimated AN ESTIMATED
6,6 million people, most of them with no
alternative for accessing health services
6,6 MILLION 1.1.1 What is the Results-Based in The results to be achieved and payments
PEOPLE Health Financing Strategy? / to be received are laid down in contractual
except for the public health system. The
Results-Based Financing in Health is the relationships between the diferent actors
nature and extent of the RBF programme
transfer of resources to health providers in the health system. Verification of the
makes sense when placed in the broader
on condition that measurable action will/ results is conducted by the purchaser before
context of the state of health delivery and AIDS as well as economic stresses on
has been taken to achieve predefined payment is made. RBF intervenes on both
system in Zimbabwe in light of the the health delivery system is evident. In
health system performance targets. RBF the supply and demand side of services.
economic crisis the country has been response to these stressors, infrastructure
is increasingly being promoted by leading
trapped in for the past two decades. for health delivery deteriorated, essential
global actors as a way to eficiently and Supply side financing is concerned with
Although government has made significant medicines became scarce and staf morale
efectively increase performance in terms giving incentives to service providers for
strides, since independence, to improve hit an all-time low. Client satisfaction and
of service quality, service utilization as the results obtained while the demand
access to quality and afordable health care the confidence in the public health delivery
well as improving staf motivation in a way side angle finances the incentives to the
for the country’s citizens, the impact of HIV system dipped significantly in response.
that will ensure Universal Health Coverage beneficiaries - that is the community
12 13
RBF RBF
receiving the services. RBF for health The Health Development Fund (HDF) is
facilities seeks to facilitate the removal financially supported by the governments
of user fees, particularly for mothers and of Canada, Ireland, Norway, Sweden, the
children in order to allow more people to United Kingdom, the European Union
access health services. In the case of the and GAVI. To date, through the RBF
HDF, and for the Crown Agents intervention, programme, HDF donors have provided
performance indicators mostly relate to over 22 million dollars to health facilities
maternal, new-born and children’s health. in the country. UNICEF also plays a
prominent role in the management of
In Zimbabwe, RBF in health was piloted the HDF as well as shaping reforms in the
in two front-runner districts in July 2011 RBF programme. The organization’s role
before it was scaled up to 16 additional includes undertaking advocacy as well as
districts in March 2012. This initiative was conducting evidence-based dialogue with
spearheaded by Cordaid with funding stakeholders for resource allocation. As
from the World Bank and the Government the fund manager, UNICEF contracts Crown
of Zimbabwe. In 2014, the approach was Agents to implement the RBF Programme that support the programme. Recently, UNICEF PLAYS A PROMINENT ROLE IN THE
further scaled up to the country’s 42 rural taking the responsibility for the monitoring UNICEF was instrumental in organising MONITORING OF THE RBF PROGRAMME
IMPLEMENTATION. HERE, UNICEF COUNTRY
districts by Crown Agents, with funding from of the programme implementation across visits by among others, the Swedish REPRESENTATIVE, DR. MOHAMED AG AYOYA
the Health Transition Fund (later, continued the country. In the process of monitoring, Members of Parliament, delegates from the TOGETHER WITH THE IRISH AMBASSADOR,
HIS EXCELLENCY LIAM MACGABHANN AS WELL
under Health Development Fund). To date UNICEF sometimes coordinates visits by the EU as well as the Irish Ambassador and the AS THE IRISH CRICKET TEAM VISIT RUTOPE
the program is being implemented in all the donors as well as citizens of the countries national Cricket Team. CLINIC IN BINDURA DISTRICT, MASHONALAND
rural districts of Zimbabwe. CENTRAL PROVINCE. THE CLINIC IS ONE OF THE
14 15 FACILITIES UNDER THE RBF PROGRAMME.
RBF RBF
THE RBF IMPACT SYNOPSIS
The RBF Programme has helped improve the health delivery system and, with it, the
key maternal and newborn health indicators. Over the years, and especially over the
past year, the Crown Agents RBF Programme has achieved the following, among other
results, in the districts where the organisation intervenes:
• Improved access and quality of health services for mothers and children. The
number of women accessing ANC4+ rose from 32 874 women in 2014 to 162 556
women in 2017 in the 42 districts where Crown Agents works. The number of
children attending growth monitoring per year rose from 430 652 to 2 485 519
children over the same period.
• Helped restore confidence in the public health delivery system. Through RBF many
facilities have been refurbished or built, medicines supplied and staf morale
boosted. The service delivery in these facilities has correspondingly improved and
communities are expressing satisfaction on the services they receive.
• Empowered communities to take interest and participate in the delivery of health
services at community level. Health Centre Committees have taken the centre
stage in deciding on how to use resources prudently to meet the needs of the
communities.
• Piloted innovative and efective means of delivering health services as well as
quality assurance in the delivery of the same. Through RBF innovations have been
piloted and capacity of health staf as well as health facilities improved through
such technologies as mobile health (mHealth) and the Mobile Incentive Calculator
(mIC) which were developed and introduced by Crown Agents. Due to such
innovations and capacity development, operations of health facilities, including a
broad array of management functions have improved.
ALL THE 834 FACILITIES UNDER RBF
IN THE 42 DISTRICTS OF ZIMBABWE
WHERE CROWN AGENTS WORKS HAVE
BEEN CAPACITY BUILT TO MANAGE
DATA EFFECTIVELY FROM CAPTURING,
STORAGE, RETRIEVAL TO ANALYSIS IN
ORDER TO IMPROVE REPORTING AS
WELL AS THE SUBSEQUENT DECISION
MAKING OF HEALTH PRACTITIONERS AND
ADMINISTRATORS IN THE SECTOR.
16 17
RBF RBF
CHAPTER TWO / 2.1 RBF Improves
RBF STRENGTHENING HEALTH DELIVERY SYSTEMS
Data Management
DID YOU KNOW? in Health Facilities /
Health delivery works within a system.
In March 2018, the World Health Data management is an administrative
The service that clients access at the point
of delivery is a result of many processes
and functions within this system. When
?! Organisation issued an alert for
a potential global pandemic. A
team of medical scientists who
process that includes capturing, storing,
protecting, and analysing data pulled from
diferent sources (registers) to ensure ease
patients receive a service, they tend to
convene annually to discuss what of accessibility of the data for its users.
think that having a health worker and
new diseases pose the greatest It is the backbone of RBF and hence the
medicines is all one needs in a health
facility. Little do clients know that behind
902 2% potential of turning into a global importance of proper data management.
NUMBER OF FACILITIES THE NATIONAL DATA pandemic have concluded that
what they interact with at the point of TRAINED IN DATA ERROR RATE; DECLINED
FROM 56% BEFORE RBF they do not have any knowledge Whether it’s an individual patient’s case
service, there is a complicated support MANAGEMENT
on what it could be. However, they or a public health issue afecting a wider
mechanism to the health delivery system
are convinced that conditions are community, decision makers and health
– there is data management that monitors indicators that inform the goal of the RBF
ripe in many respects for a new service providers alike rely on access to
and improves access to quality service, Programme, as supported by the Health
pathogen to emerge and cause good data to improve both the access to
complex infrastructure that supports Development Fund. Since investments in
havoc for global health systems. and quality of health services they provide.
service delivery as well as a myriad of the system itself are less visible to the eyes
They have termed this ‘Disease Based on this data, health facilities
administrative procedures and systems, of the public, they are oten not discussed
X’. If any new disease emerges staf can measure the quality of health
among several other components of the or understood. Hence stakeholders tend
as have HIV, SARS and Ebola in services they provide and make necessary
health delivery system that clients do not to rush to complain that resources have
recent decades, the developing adjustments if there is a need to. Medical
interact with every day. Needless to say, gone missing if they do not see them
world is likely to bear the brunt practitioners can also use holistic patient
accessing and enjoying quality services going into staf salaries, medicines or
of the new pandemic – they have data to personalise treatment for patients
at a health facility is only possible when any other components of the health
weak health systems hence limited hence improving the general well-being of
these various components are designed system that are at the point of accessing
capacity to contain or respond the patient. At the broader national health
and supported to deliver such services services. Government and its partners in
to new pandemics should they systems level, several benefits accrue
efectively. health financing have an obligation to
emerge. The RBF’s intervention from good practices of data management.
communicate to all stakeholders about the
in strengthening health systems Good data management practices can
The RBF Programme is alive to the complexities of financing the health sector.
is therefore an important help health systems to predict and prevent
dynamism of the health delivery system. To If this is done clearly, it can even enhance
contribution in addressing the public health catastrophes as well as
this end, Crown Agents and its partners have the participation of more stakeholders,
public health systems’ capacity to model public health programmes and
invested a significant amount of resources, including communities in public health
respond, not only to known public policies that respond to certain diseases
including capacity strengthening, in these issues. In this edition we celebrate the
health issues of the day but also and conditions deemed prevalent in the
various components of the health delivery investments made by the RBF Programme
those of the future – pandemics communities served. In essence, good
system. The successes of these investments in the processes behind the scenes and we
now confirmed by science as data management strengthens the health
are evident in both the state of the health bring this out to the public eye through
inevitable. delivery systems and increases individual
delivery system in the districts where RBF some visible changes that clients may
is being implemented as much as they are see but without understanding the story patients’ treatment outcomes.
in the key maternal and newborn health behind them.
18 19RBF RBF
BENEFITS OF GOOD DATA
MANAGEMENT PRACTICES
systems and outcomes, Crown Agents invested
a substantial amount of time, skills and other
resources in capacity development for better
QUESTION AND ANSWER /
data management. Hence, all the 834 facilities
HOW THE RBF PROGRAMME HELPED IMPROVE DATA MANAGEMENT:
There are several benefits that come with under RBF in the 42 districts of Zimbabwe where
Crown Agents works have been capacity built to CROWN AGENTS DATA MANAGER SPEAKS
efective data management practices:
o Help measure health care quality and manage data efectively from capturing, storage,
making improvements were there are retrieval to analysis in order to improve reporting
gaps. as well as the subsequent decision making of
health practitioners and administrators in the The Editor caught up with the Crown Agents is to be paid out to the said facility. RBF is all
o Readily available holistic patient data Data Manager (DM) to discuss the role that about being incentivised to produce results and
is helpful in personalising treatment for sector. This process of capacity development is
bearing fruits. Crown Agents has played in developing the good data is testimony to the results achieved.
patients hence improve the general well-
capacity of health facilities in managing
being of individual patients.
data efectively as well as the results of the The Editor: In that case then, do you imply that
o Improvement in the day to day running
intervention. Here are the snippets of the data management is self-serving – we only need
of the facility allowing management to
WHAT IS DECLARED DATA? interview: good data for the purpose of paying facilities on
plan ahead.
Declared data is the data recorded by health the basis of results achieved?
o Improve population health outcomes
by tracking current health trends and facilities on the MoHCC T5 form. This data The Editor: Can you explain to us what data
predicting future ones. is sourced from the health facility registers. management is, in the context of health systems DM: Far from it, that is only one of the many
o Awareness campaigns are being planned The recorded data will in turn be entered management? reasons. There are several other benefits that
according to conditions reported to be in in the MoHCC database called the District accrue to the health system and patients. For
need. Health Information System (DHIS). DM: Data management is an administrative example, we need data to improve the quality of
o Disease prevention plans are made and process that includes capturing, storing, service to individual patients as well as to plan
executed according to area of need. UNDERSTANDING THE PROCESS protecting and analysing data pulled from and model public health programmes. Data tells
OF VERIFICATION IN RBF diferent sources (registers) to ensure ease of us the prevalence of certain diseases in certain
Verification is a process of checking on the accessibility of the data to its users. It is the localities upon which responses and prevention
Despite these clear benefits of efective data data declared against what is actually in the
backbone of RBF and hence the importance of programmes can be fashioned.
management practices, the principles and registers which are the source documents.
practices of data management seemed to be proper data management.
This process also entails checking for
The Editor: Seeing to it that data management is
lost on health facilities before RBF. Lack of completeness of a record thus checking for
The Editor: You say that data management ‘is that important, what role did Crown Agents play
capacity, competing priorities in the face of date, sex, full address, age and full name
the backbone of RBF and hence the importance to improve data management practices in the
resource scarcity as well as demoralisation of patients. The process of verification is
of proper data management.’ Can you explain context of the RBF Programme?
of staf, among other factors, saw data important as such data has implications on
management practices in many health the national policy making as well as taking what you mean by that?
facilities deteriorating over the years. key decisions at various levels of the health DM: Our RBF programme invested in capacity
delivery system. In the end, verification DM: While you may probably be interested in building on how data should be managed. For
The introduction of the RBF programme has helps improve the quality of services ofered how the RBF programme has helped develop all the 834 facilities we are working with, we
however, already, started turning around at health facilities. the capacity of health facilities to manage undertook on-the-job training. We believe that
the situation for health facilities and the data efectively, you may also need to realise this approach is more efective and practical
national health system at large. Of the The first level of verification is done by the that data management is important in the RBF compared to classroom learning. We also
total budget allocated to RBF Programmes, management at the health facility. Crown incentivised the correct capturing of data by
programme. It is on the basis of this data that the
Crown Agents spent a significant percent Agents conducts the second level data RBF programme thrives; through data HFOs are the health facilities staf. In these trainings, we
of this amount on building the capacity of verification as well as the quarterly exit
health facilities to deliver services. With able to verify the results of each health facility were emphasising the importance of data and
interviews. The organisation analyses the
efective data management strategies and be able to determine or calculate how much benefits of efective data management.
data and prepares reports that are shared
playing such a key role in improving health with other stakeholders to demonstrate
progress on the indicators of the HDF
programme.
20 21RBF RBF
2.1.1 Data Management and the Verification Process: The
Backbone of the RBF Programme /
Crown Agents has noticed a significant improvement in the quality of
declared data since the introduction of the RBF Programme. At the beginning
of the programme in the second quarter of the year 2014, the average
national error rate was a whopping 56 percent. Data registers were not
updated correctly and regularly hence incomplete. This poor management
of data weakened the health delivery system at both the level of the health
facility as well as collectively at the national systems level. Enter RBF, the
error rate went down significantly to 2 percent by the third quarter of 2017.
Once verification is done the data error rate is less than 5 percent, the
health facility is paid their dues based on the results demonstrated in the
data provided. In the end, one could argue that verification is a quality
assurance process and an extension of the capacity building process -
during verification, HFOs use the opportunity to further train and support
health facility staf in data management so as to help them improve their
earnings. In essence verification is critical to the RBF Programme because it
is the basis upon which health facilities are financed.
VERIFICATION: WHO DOES WHAT?
• Crown Agents Zimbabwe, through
The Editor: And, what results have you witnessed RBF, ofers support to the district
following this process? by incentivising data verifications
conducted by community nurses, and
DM: Before the inception of RBF some health national committee. For example, in Murehwa also incentivising quality supervisions.
facilities would record incomplete data that and Uzumba Maramba Pfungwe districts, 90% Capacity building for performing these
was dificult to make use of. Registers were kept of facilities are now operating at an error rate of supervisory roles is provided to maintain
haphazardly such that during the reporting less than 5% which is a positive development. high standards.
• At provincial level the MoHCC makes sure
period, data would be misrepresented. We RBF has processes and procedures in place that
that the data is captured in the system
undertake a process of verification for the data promote data correctness and completeness
at an agreed time and supervises the
kept by the health facilities to ensure that there through a 5% rule that stipulates that if a performance of the district.
are no errors that can distort the interpretation facility’s error rate on data completeness is • At national level guidance is provided
of results attained by each facility. The process below 5% the heath facility earns a subsidy; to the provinces that further cascades
of capacity building in data management as otherwise the facility earns nothing. Due to this down the same to the districts. Processes
well as the verification has greatly improved intervention, the average national error rate has and procedures are defined to support
the quality of data. To date, almost all facilities since declined from the 56% in 2014 to 2% in improved data management at provincial
have valid records which are useful to the 2017. and district levels.
22 23 23RBF RBF
MOHCC LAUDS RBF ROLE IN FIG 1: AVERAGE DATA QUALITY PROGRESSION FOR HDF - SUPPORTED FACILITIES
(2014-2017)
IMPROVING DATA QUALITY / 60%
50%
49%
40%
The Makoni District Health Information Mr. Mushore is of the opinion that the
Oficer (DHIO) has commended the role that Ministry has noted a vast improvement
30%
the RBF Programme is playing in improving in these areas and their district is grateful
data management in health facilities in to the RBF Programme. Not only has data 30%
the district and country at large. Speaking quality improved in Makoni district; such
about how RBF has helped facilities trends are noticeable countrywide as 10%
improve data management practices, Mr. depicted in the graph below:
Tawanda Mushore said, ‘Completeness of 0% 2%
reports has improved and data registers are 2.2 Improving Quality of Services / 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017
now being updated regularly and correctly.’ Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
He added that ‘Before the introduction of As has already been noted, RBF concerns
the RBF Programme our registers across itself with improving access to health
the district had lots of gaps. We are pleased services by many people in rural, oten
to see that with the RBF intervention, poor, communities. However, such access
data is now being verified; there is now is not helpful if the services are not of an
data consistency. Even reporting is now expected minimum standard of quality
comprehensive and timely.’ required to successfully treat a patient.
To ensure such quality standards are met,
Before the introduction of the RBF the RBF supports the process of quality
Programme, the MoHCC faced many assessment by relevant supervisors in the
challenges with regards to data health system.
management. These include among
others:
• Late submission of reports to the Quality assessments are monitoring
district ofice from health facilities activities conducted by DHEs to assess
• Incomplete registers leaving out whether structural, managerial and clinical
important data procedures are up to standard and are
• Inconsistences between data captured being done properly.
and the data in source documents.
NURSE VERIFYING THE ANC REGISTER.
VERIFICATION IS IMPORTANT IN
IMPROVING DATA QUALITY AND THE
OVERALL SUCCESS OF THE RBF
PROGRAMME.
24 25RBF RBF
Onsite data verification at 2.2.1 Quality Assessments: RBF
Nhawa Clinic, Rushinga District beyond the Numbers /
While verifying numbers is easy in the
context where data management practices
are improving, quality assessments may
be far more complicated and require a
He added that ‘Before the diferent mechanism. Yet, it is important
introduction of the RBF that the quality of service is guaranteed
Programme our registers across
the district had lots of gaps. We
since it is quality that determines if the 337
NUMBER OF NURSES
are pleased to see that with the served patient is going to be satisfied
IN 5 DISTRICTS OF
RBF intervention, data is now by the service or have their health issue
MASHONALAND WEST
being verified; there is now data resolved. So how does the RBF Programme
consistency. Even reporting is PROVINCE TRAINED IN
ensure the services provided and paid for MIDWIFERY
now comprehensive and timely.’
are of a high quality? The answer is in the
District Health Executive (DHE) Quality
Assessments.
The DHE is made up of the District Medical Second is the Client Satisfaction Score
Oficer, District Nursing Oficer, District (CSS) where the basis of measure is the
Health Services Administrator, District clients’ perceived level of satisfaction with
Accountant, District Environmental Health the services provided by a particular health
WHY QUALITY ASSESSMENT MATTERS structures are suitable for service delivery or
plans are being implemented as well as how Oficer and the District Pharmacist. They facility.
Quality Assessments (QAs) allow supervisors
to observe, identify knowledge gaps as well as staf is being allocated duties, among other have a quality scoring system they use to
monitor and evaluate the activities of a health supervisory functions. This allows DHEs to assess the quality of facilities. Quality of The third component, on the other hand,
facility. The assessment is concerned with scrutinise the clinical services focussing on service is assessed using a carrot and stick focuses on the assessment of Crown
whether activities are done properly according staf know-how and identify knowledge gaps in
scoring system where health facilities are Agents’ field staf (P/HFOs) and Ministry
to set procedures and, if not, define steps to order to recommend trainings. These trainings of Health verifiers (SICC). This component
will then help to improve staf knowledge hence
penalised for not having quality systems
improve the same. In essence, QAs allow DHEs to
in place or rewarded if they do. The quality is concerned with quality control, support
take lessons learnt and give instant feedback to the quality of service. Post QAs, a total number and supervision whose basis for measuring
of 337 of nurses in 5 districts of Mashonaland of service ofered by a health facility has
their subordinates as well as their supervisors. quality is accuracy of verification and
The mere fact that service providers know that West province have been trained in midwifery three components, the first two of which
focus on the quality of the health facility adherence to set programme guidelines.
they are being supervised pushes them to do implying that most deliveries are now being
their best, especially if they know that delivery conducted by trained midwives. In addition, and their staf. The components include,
of high quality services will be incentivised and QAs also allow the DHEs to monitor essential to begin with, the DHE quality score where 2.2.2 Improved Quality Increases
poor quality punished. medicines supply and the facility stocks. In the basis of assessment is: Earnings /
the end they can recommend facilities to Already, we have documented how RBF
In addition, QAs allow the DHEs to be in touch either maintain the available stocks or procure
• The quality of the health facility links the numbers of people who are
with the health delivery system in a practical additional drugs hence ensuring continued served by a health facility to the facility’s
improvement in the quality of service delivered
infrastructure
manner. Through the assessments, the DHEs
• The quality of management and earnings. However, there are other factors.
have an opportunity to check whether the to clients. The RBF recognises that reaching out
planning systems
• The quality of clinical management to many people with health services is
and services provided only half the task. In order to deliver an
26 27RBF RBF
efective public health service, the quality
of the service equally matters. Against
both quantity and quality being essential
to the formula. BANGURE CLINIC: THE IMPACT
this background, quality just like quantity
must be incentivised. Hence, the formula
for facilities’ earnings looks beyond mere
From the diagram below, it is clear that
health facilities can earn more money by
OF QAS ON SERVICE DELIVERY /
numbers; it also assesses the quality of the improving the quality of services and not
service among other factors that ensure just the numbers. In turn, this money can
FIG 3: OVER THE YEARS, THE QUALITY OF SERVICES IN BANGURE CLINIC HAS GENERALLY
equity and fairness in the disbursement of be used to improve service delivery in the BEEN ON AN UPWARD TRAJECTORY AND SO HAVE BEEN THE EARNINGS
subsidies. The diagram below explains the health facility as the story of Bangure clinic
mechanism for calculating earnings with below shows.
4500
4000 4188.89
3500
Total Amount Paid for Amount Paid for Amount Paid for Quality of Services 3000 3329.8
Subsidy Quantity of Services Remoteness Bonus • Based on quality score attained 2500
• Number of services X (purposes of equity) • Score is checked against the four
2000
= unit price • Based on 5 remoteness
indicators
• Each can attract a
quality ranges in order to determine
which percentage of the capped
monthly amount the facility will earn
1500
1000 467.95
882.4
maximum bonus of 6% • Maximum capped amount of quality 500
(maximum 30%) bonus a facility will be getting per 0 0
• Reviewed on a quarter is $4,615
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
6-monthly basis by the • Each component of the checklist
2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017
+ DHE and the CSS tool is assigned prices
based on their weight (weight is
based on the 2017 Quality Supportive
Quantity Quality
Supervision checklist)
+ • Structural (0.09) $413.1,
Management and Planning (0.23)
$1053.7, Clinical Management (0.48)
Located in the Buhera District of Manicaland
Province, Bangure clinic is a perfect case
and work hard in order to deliver quality
under whatever circumstances. Even
$2225.5, Client Satisfaction Survey study of how the RBF programme has when she went for upskilling in midwifery
FIG 2: MECHANISM FOR CALCULATING THE (0.20) $923.1. improved the quality of services through in the 4th quarter of 2015, her team was
• Calculation of quality bonus – if the aid of quality assessments. Since the motivated to work together to maintain
SUBSIDY FOR A FACILITY: THE TOTAL SUBSIDY the overall quality score isRBF RBF
2.3 Money Well-Managed is The financial management training covers
Drums and tins used to Lives Saved: RBF Helps Improve the following key aspects that improve
store water at the clinic the facilities’ capability to prudently and
before the installation of Financial Management Practices in
efectively manage resources for the
the solar pump Health Facilities /
purposes of improving service provision:
According to the Centre for Global
• How to record transactions in the cash
Development, many countries sufer
books
from ineficiency and corruption that
• How to use bank statements when
compromise the public health delivery
preparing bank reconciliations
system.1 To address both of these related
• Procurement procedures when
problems, it is important to improve
procuring goods/services
the systems through which finances are
• Good filing systems and keeping
managed in the public health sector.
auditable documents
Research has shown that investment
• Financial planning and analysis
in financial management systems ‘is
• Financial reporting
worthwhile as a supporting mechanism
to delivering better health services.’2
When the financial systems of health
Such financial management systems are
facilities are strong, leakages of
beneficial in the sense that they provide
resources through financial management
reliable financial transfers as well as
malpractices and corruption are limited.
provide useful data to inform policy
This means more money going into
choices on levels and equity of funding
procurement of medicines and improving
and, generally, can support accountability
the quality of service, among other
hence deal with leakages such as
functions of the public health system.
corruption or mismanagement of funds.
Villagers ofloading river
sand, stones and bricks
The RBF Programme understands the link 2.3.1 Electronic Platforms
at Bangure Clinic as they
help in the construction of between financial management and public Introduce Ease of Transaction /
a Waiting Mothers Shelter. health outcomes hence the investment It is important to note, however, that the
and innovation of Crown Agents in the support of Crown Agents under the RBF
way financial resources are managed. Programme is not only concerned with
To this end, Crown Agents is training ensuring that there are no leakages, it is
and supporting all districts in financial also about improving the ease of financial
management. In 2017, 38 percent of the management processes. To this end, Crown
districts were trained and provided with Agents has been helping health facilities to
supportive supervision. The remaining migrate to the electronic payment system.
Waiting Mothers’ Home in its final stages of construction at districts will be trained and supported in
Bangure Clinic. With better quality, facilities earn more and with the first half of 2018. The electronic payment system is a way of
more earnings, facilities can do even more for the communities making payments for goods and services
they serve. electronically instead of using cash or
1 Working Paper Number 78, January 2006: Governance
and Corruption in Public Health Care Systems, Maureen
filling-in and submitting hard copies for
Lewis
2 Overseas Development Institute, 2017
30 31RBF RBF
MAP 1: COVERAGE OF THE FINANCIAL MAP 2: STATE OF THE ELECTRONIC
MANAGEMENT TRAINING AND CHIRUNDU
PAYMENT SYSTEM TRAINING AND
MBIRE CHIRUNDU
SUPERVISION BY CROWN AGENTS CENTENARY
SUPERVISION UPTAKE. MBIRE
CENTENARY
ACROSS THE DISTRICTS KARIBA URBAN
HURUNGWE
HURUNGWE RUSHINGA
KARIBA URBAN
HURUNGWE
HURUNGWE
MT DARWIN
RUSHINGA
MT DARWINI
GURUVE GURUVE
KARIBA KARIBA
SHAMVA SHAMVA MUDZI
MUDZ
MAKONDE
MAKONDE MAKONDE
MAKONDE
MAZOWE MAZOWE
CHINHOYI CHINHOYI
CHINHOYI
GOKWE NORTH MUTOKO MUTOKO
GOKWE NORTH GOKWE NORTH
ZVIMBA ZVIMBA
HARARE URBAN MUREWA HARARE URBAN MUREWA
VICTORIA FALLS BINGA NYANGA VICTORIA FALLS BINGA
HARARE RURAL HARARE RURAL
NORTON NORTON
CHEGUTU CHEGUTU
GOKWE SOUTH SEKE SEKE
KADOMA TASAMAKONI
MARONDERA
GOKWE SOUTH KADOMA MAKONI NYANGA
MARONDERA
HWANGE URBAN RUSAPE HWANGE URBAN RUSAPE
MU MUTASA
HWEDZA HWEDZA
HWANGE LUPANE HWANGE LUPANE KWEKWE
NKAYI KWEKWE CHIKOMBA CHIKOMBA
MUTARE URBAN NKAYI
REDCLIFFE MUTARE URBAN
REDCLIFFE
CHIRUMANZU
CHIRUMANZU MUTARE MUTARE
GWERU ANIMANI BUHERA
GWERU
TSHOLOTSHO TSHOLOTSHO
BUBI BUBI
GUTU BUHERA GUTU
UMGUZA SHURUGWI UMGUZA SHURUGWI
CHIM CHIMANIMANI
BULAWAYO MASVINGO URBAN BULAWAYO MASVINGO URBAN
BIKITA BIKITA
BULILIMA INSIZA BULILIMA INSIZA
ZVISHAVANE CHIPINGE ZVISHAVANE ZAKA CHIPINGE
ZAKA ZAKA
MASVINGO MASVINGO
CHIVI
MBERENGWA CHIVI MBERENGWA
MANGWE MANGWE
MALOBO COMPLETE MALOBO
GWANDA MWENEZI
SENT TO BANK GWANDA MWENEZI
CHIREDZI CHIREDZI
PENDING
SUPERVISED
BEITBRIDGE BEITBRIDGE
PENDING SUPERVISION
BEITBRIDGE URBAN BEITBRIDGE URBAN
Real Time Gross Settlement (RTGS). It the RTGS cost. It is even more cost However, this process has not been
means payment of goods and services efective if one considers that no without challenges. Across all the rural
using an internet-based platform rather travelling costs to the bank are health facilities there seems to be fear and
than visiting the bank. involved. lack of confidence in using technology
• It is convenient and time-eficient as especially when it comes to finances. This
Although the map below shows that uptake payments can be done any time at is also compounded by poor connectivity
of the electronic payment system has been the DHE ofices. Notably, payments to the internet in many rural communities.
slow, the system has several benefits: are done concurrently when DHEs These challenges partly explain the slow
• It is faster and cheaper than cash or review and authorise procurement uptake of the electronic payment system.
RTGS transactions hence saves time documents.
and money. RTGS costs $5-$10 per • The electronic payment system in use
transaction while electronic banking is user-friendly.
costs only less than 20 percent of
32 33RBF RBF
CHAPTER THREE /
RBF IMPACT IN PERSPECTIVE
The stories in this publication have earnings. Masvingo province (see story
illustrated massive investments that below) is an example of the impact of RBF
have been made in the health systems, evident in earnings.
particularly for rural health facilities. These
investments have helped support facilities to MASVINGO PROVINCE LEADS IN RBF
improve the quality of services they provide, EARNINGS /
increase the reach of their services as well Between the third quarter of 2016 and the
as strengthen their financial management third quarter of 2017, Masvingo Province
systems in order to maximise on the limited was leading in terms of earnings (see
resources available. The results of such table below). Earnings are one of the
huge investments must be visible for both components that reflect the success of
the clients and other stakeholders in the the RBF programme since they are tied
health delivery sector. In this chapter, we to maintaining high quality of services
highlight some of the visible results of the and the reach of the same. In the light of
RBF Programme. this knowledge, there is no doubt that
the teams in the health facilities and the
3.1 Improved Earnings: Rewards for province worked hard throughout the
Producing Results / year. With high quality of services and
high numbers of clients served, it is only
The quantity and quality of services provided a matter of time before statistics come
are among the determinants of health through to demonstrate the impact
facility earnings in RBF. Over the years, through key health indicators of concern to
many facilities have been realising increased the HDF.
earnings under the RBF
‘BEFORE THE INTRODUCTION OF THE RBF Programme. While increased TABLE 1: TOP RBF EARNERS FOR THE PERIOD Q3 2016 –
PROGRAMME OUR REGISTERS ACROSS THE earnings themselves are a Q3 2017, MASVINGO DOMINATES
DISTRICT HAD LOTS OF GAPS. WE ARE sign of the RBF impact in some
PLEASED TO SEE THAT WITH THE RBF respects, the importance of FACILITY AMOUNT ($) DISTRICT PROVINCE
INTERVENTION, DATA IS NOW BEING VERIFIED; RBF is made prominent by the Bota Clinic 44,880.80 Zaka Masvingo
THERE IS NOW DATA CONSISTENCY. EVEN
stories of how health facilities Gutu Rural Hospital 45,163.82 Gutu Masvingo
REPORTING IS NOW COMPREHENSIVE AND
are working hard to increase Bikita Rural Hospital
TIMELY.’ 46,713.42 Bikita Masvingo
their earnings as well as the
Chikuku Rural Hospital 47,040.78 Bikita Masvingo
investments they are making
in their facilities through such Dotito Rural Health Centre 48,827.96 Mt. Darwin Mash Central
34 35RBF RBF
Earning such a prestigious spot takes province team is only representative of TEAM WORK: HOW MASVINGO PROVINCE GOT IT RIGHT
concerted eforts of many stakeholders. the team spirit, commitment and desire When, decades ago, Henry Ford remarked that, “If everyone is moving forward
However, one can never discount the to serve communities that exists in all the together, then success takes care of itself,” he knew nothing about RBF or the team
support of the provincial team – both provinces. The province may be leading in Masvingo working on this program. The great American captain of industry
the MoHCC and Crown Agents provincial in the past year but many other provinces was probably just sharing conventional wisdom he had gleaned from years of
support teams. It is unlikely that the have put equal investment and dedication. experience in business.
prevalence of success in one province This is why the list of consistent performers
But, wisdom knows no limits in time and space; it endures all confines and, hence,
over a single year could happen without is made up by diferent provinces. (See many years ater Ford’s demise, what he learnt about teamwork found currency a
such support. However, Masvingo table below) thousand miles away in Zimbabwe’s oldest town, Masvingo. Ater dominating the
top 5 of RBF earners for the year 2016 to 2017, the Provincial Medical Director for
the Masvingo province, Dr Shamu tends to agree with Ford’s observation. ‘We are
happy to know that our province has realised such huge success. Teamwork is at
TABLE 2: RBF CONSISTENT EARNERS (Q3 2016 TO Q3 2017) the centre of our success,’ he observed.
FACILITY TIMELINE With a total of 119 clinics under RBF program in the province, Masvingo occupies
Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 (Q3 17 ) % increase all the top 4 spots amongst the highest earners for the period Q3 2016 to Q3 2017,
- (Q3 16) in earnings with Mashonaland Central grabbing the fith. Ater training the various actors and
adhering to the prescriptions of the RBF program, the Provincial Health Promotion
Dewure II Rural Health 964.65 1,209.33 1,420.35 1,976.77 4,684.3 3,719.65 36%
Centre
(PHP) Oficer, Mr. Casper Nhemachena observes that everyone is playing their part.
‘Team work is the catchword in Masvingo,’ he emphasised.
Epworth Mission Clinic 858.31 866.28 1,586.28 1,264.64 3,656.14 2,797.83 34%
Hozvi Clinic 899.15 1,039.95 1,495.45 1,406.03 3,337.92 2,438.77 30% Teamwork is only possible when the various actors know their place in the team
Muzokomba Clinic 1,708.76 2,336.76 2,319.13 4,311.93 6,865.79 5,157.03 29%
and are willing to play it. Masvingo province invested significantly in the training
of various stakeholders among them the DHEs, health facility staf and the HCCs.
Bikita Rural Hospital 4,761.09 4,546.89 7,903.58 11,382.03 18,119.83 13,358.74 29% And such capacity development eforts are paying of. ‘The RBF in Masvingo is
Mandara Clinic 2,397.40 2,196.61 4,522.70 6,436.13 9,503.70 7,106.30 28% community driven and communities work with health workers. Ownership has
Chikuku Rural Hospital 2,741.83 2,708.80 9,703.27 15,929.36 15,957.52 13,215.69 28%
moved to communities with HCCs spearheading all health facility development
issues. This has lessened the burden for health workers, who are now focusing on
their core business of improving the quality of care,’ said the PHP.
Since Masvingo province dominates the list of our top earners for the period Q3 2016 to Just like every team needs a leader, the Masvingo province leadership was
Q3 2017, we caught up with the provincial leadership team consisting of the Provincial exceptional in this regard. They availed themselves throughout to support and
Medical Director, the Provincial Nursing Oficer and the Provincial Health Promotion mentor the health facilities. It helped that the health workers themselves were
Oficer, who all shared important insights into their success story. already motivated, noted the Provincial Nursing Oficer, Mrs. Mavis Gumbo. ‘The
25 percent incentives payment is motivating our health workers to do their best.
No doubt, there is all the ingredients for success in Masvingo – a motivated team
and a leadership willing to serve. What if we add a community that is willing and
able to participate in the running of their own health facility? One can only wait
and see if Masvingo province can outdo itself in the coming months.
3.2 Using Earnings to Improve Health Facilities: Stories of Impact
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