The political economy of results-based financing:the experience of the health system in Zimbabwe

作     者：Sophie Witter Yotamu Chirwa Pamela Chandiwana Shungu Munyati Mildred Pepukai Maria Paola Bertone 

作者机构：ReBUILD programmeQueen Margaret UniversityEdinburgh EH216UUUK ReBUILD and Biomedical Research and Training InstituteP O Box CY 1753HarareZimbabwe Biomedical Research and Training InstituteP O Box CY 1753HarareZimbabwe 

出 版 物：《Global Health Research and Policy》 (全球健康研究与政策（英文）)

年 卷 期：2019年第4卷第1期

页      面：180-196页

学科分类：0711[理学-系统科学] 07[理学] 08[工学] 081101[工学-控制理论与控制工程] 0811[工学-控制科学与工程] 071102[理学-系统分析与集成] 081103[工学-系统工程] 

基　　金：funded by the Department for International Development UK Aid under the ReBUILD grant.However the funders take no responsibility for the views expressed in this article 

主　　题：Political economy analysis Results-based financing Zimbabwe Health financing reforms Fragile and crisis-affected settings 

摘      要：Background:Since 2000,results based financing(RBF)has proliferated in health sectors in Africa in particular,including in fragile and conflict affected settings(FCAS)and there is a growing but still contested literature about its relevance and *** examined are the political economy factors behind the adoption of the RBF policy,as well as the shifts in influence and resources which RBF may bring *** this article,we examine these two topics,focusing on Zimbabwe,which has rolled out RBF nationwide in the health system since 2011,with external ***:The study uses an adapted political economy framework,integrating data from 40 semi-structured interviews with local,national and international experts in 2018 and thematic analysis of 60 policy documents covering the decade between 2008 and ***:Our findings highlight the role of donors in initiating the RBF policy,but also how the Zimbabwe health system was able to adapt the model to suit its particular circumstances-seeking to maintain a systemic approach,and avoiding *** Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s,it retained managerial and professional capacity,which distinguishes it from many other FCAS *** active adaptation has engendered national ownership over time,despite initial resistance to the RBF model and despite the complexity of RBF,which creates dependence on external technical *** was also aided by ideological retro-fitting into an earlier government performance management *** main beneficiaries of RBF were frontline providers,who gained small but critical additional resources,but subject to high degrees of control and ***:This study highlights resource-seeking motivations for adopting RBF in some low and middle income settings,especially fragile ones,but also the potential for local health system actors to shape and adapt RBF to suit their needs in some circ