Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe
Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe
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DOI：
10.1108/jhom-06-2020-0215
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发表时间：
2021-01-06
影响因子：
1.4
通讯作者：
Gwati, Gwati
中科院分区：
文献类型：
--
作者：
Kadungure, Artwell;Brown, Garrett Wallace;Gwati, Gwati
目的：本研究考察津巴布韦成果筹资方案在2010年至2017年期间发生的关键适应，找出需要适应性应对的内生和外生因素以及做出改变的过程。设计/方法/方法：本研究基于案头审查和对政策和学术文献的专题分析，并辅之以28个多方利益攸关方访谈。研究结果：该方案在2010年至2017年期间经历了实质性的适应，显示出对提高效率以及应对破坏成果筹资机制的不可预见因素的显著反应水平。该方案具有适应性，因为它的分阶段设计允许修订能力和反应适应，这为其他中低收入国家环境提供了有用的见解，在这些国家，逐步扩大规模可能更好地满足具体情况的需要。然而，RBF评价往往没有系统地审查或报告外部因素，这表明本可以更好地预测、规划、报告和沟通适应，特别是如果RBF要成为更有效的卫生系统改革工具的话。然而，对于外部因素如何影响成果管理制绩效存在疑问，并认识到不可预见的内生性方案设计和执行因素也极大地影响了成果管理制的绩效。因此，有必要更好地了解成果管理制是如何运作和适应方案一级的(内生)和外生(外部)因素的。
Purpose: This study examines key adaptations that occurred in the Zimbabwean Results-Based Financing (RBF) programme between 2010 and 2017, locating the endogenous and exogenous factors that required adaptive response and the processes from which changes were made.Design/methodology/approach: The study is based on a desk review and thematic analysis of 64 policy and academic literatures supplemented with 28 multi-stakeholder interviews.Findings: The programme experienced substantive adaption between 2010 and 2017, demonstrating a significant level of responsiveness towards increasing efficiency as well as to respond to unforeseen factors that undermined RBF mechanisms. The programme was adaptive due to its phased design, which allowed revision competencies and responsive adaptation, which provide useful insights for other low-and-middle income countries (LMICs) settings where graduated scale-up might better meet contextualised needs. However, exogenous factors were often not systematically examined or reported in RBF evaluations, demonstrating that adaptation could have been better anticipated, planned, reported and communicated, especially if RBF is to be a more effective health system reform tool.Originality/value: RBF is an increasingly popular health system reform tool in LMICs. However, there are questions about how exogenous factors affect RBF performance and acknowledgement that unforeseen endogenous programme design and implementation factors also greatly affect the performance of RBF. As a result, a better understanding of how RBF operates and adapts to programme level (endogenous) and exogenous (external) factors in LMICs is necessary.