Global interest in results based financing (RBF) as a means of strengthening health systems
and improving service delivery coincides with heavy Zambian investment in its health sector—but with
poor maternal and child health (MCH) outcomes. Determined to remedy the situation, Zambia pre-piloted
an RBF project in Katete district aimed at testing how RBF can be adapted to the country context and its
suitability in strengthening the health system and improving service delivery.
This case study reviews the design and implementation of the Katete RBF Pre-Pilot and explores its
impact on access and utilization of MCH services and health systems strengthening. The research team
used a mixed-methods approach, collecting qualitative and quantitative data through semi-structured
interviews, group discussions, document reviews and financial and health service delivery databases.
Changes in performance indicators were estimated using an interrupted time series analysis
complemented by a simulated modeling analysis.
In Katete, RBF increased immunization coverage of children less than one year old by 4 percent and
curative consultations by 14 percent between 2008 and 2012. These achievements were facilitated by
some health system improvements such as increased managerial autonomy and local decision-making at
service delivery levels, enhanced staff performance and teamwork, and community participation. Despite
these gains, the project experienced some delays in RBF disbursements to health facilities and increased
staff workload due to increased utilization of health services. The study revealed clients’ perceptions of
high service quality despite low technical quality scores.
RBF can be used to improve health system performance and service delivery quality. However, the
implementation and effects of RBF are context-specific and the model has to meet certain key design
criteria and requires basic inputs for RBF to work effectively.