RESULTS-BASED FINANCING IN HEALTH PROGRAMME

Driving Team Work and Collaboration to Achieve UHC*

DECEMBER 2019

*Universal Health Coverage FOREWORD /

THE RBF SINCE 2012, PROGRAMME MATERNITY IS BEING rural districts 842 WAITING HOMES 42 HAVE HELPED CUT DOWN IMPLEMENTED covering a total of rural health facilities MATERNAL BY DEATHS CROWN It serves BY AT LEAST AGENTS 67 an estimated IN... hospitals across million 50%. the country 6,6 people

352 405 5 138 318 OVER 2000 IN 18 Number of women Number OF Growth HEALTH WORKERS RURAL DISTRICTS accessing ANC4+ Monitoring VISITS FOR WERE TRAINED RBF IS BEING in 2018 UNDER 5 CHILDREN in IN OPERATIONAL IMPLEMENTED BY 2018 TRAINING MoHCC PCU

that are supported by higher levels of care in the system. ?! About the Results-Based Financing (RBF) in Health Programme The Health Development Fund (HDF) is a multi-donor fund to the Zimbabwean health sector, INTERNATIONAL This approach, consistent with the goal of universal health with a focus on Reproductive, Maternal, Newborn, Child and Adolescent Health. The RBF coverage, will ensure the whole population has access to programme is financed from this fund. Under the RBF, transfer of resources to health facilities UNIVERSAL HEALTH is on the condition that measurable action will/has been taken to achieve predefined health COVERAGE health services and that there are no exclusions as a result of 2% system performance targets. The AVERAGE data financial hardship. error rate ON RBF The infographic above shows the coverage and impact of the RBF programme under Crown INDICATORS declined Agents since 2014. The government has set a target to construct 6,600 new from 56% before RBF The Zimbabwean Ministry of Health and Child Care (MoHCC ) is health posts within the next five years to ensure that every strengthening primary health care through decentralisation. citizen has easy access to healthcare. No citizen should have Services provided by Rural Health Centres are being offered limited access to health services due to distance. To achieve at village health points which now offer a package of services that, the government is working on ensuring that no citizen

1 2 2 www.crownagents.com Permanent Secretary for Health and ChildCare Dr. Agnes Mahomva morale ofhealthworkers delivery. inservice improved and citizens, of status economic of regardless affordability access, easy towards work efforts these All reduce therisk. to helping is this and exists now population alert an and increase disease burdenrisk of are reduced.A conscious may that determinants social that ensure to citizens the education (through advocacy and communication) among Furthermore,incorporatedhas MoHCC robust health access to healthcare at anaffordable cost. citizens’ enhance to expected is this and year fiscal 2020 the for billion USD$6.5 of budget a MoHCC allocating by Coverage Health Universal government enhancing to committed The has escalate. to continue care accessing costs for as service, health also the on have negatively impacted challenges macro-economic prevailing The Fees. see User to reduced will due citizens), affordability and all access improved for cater (to Scheme Insurance Health National a finance of developmentsector. The health the and to support inclusion donor total on over-reliance ensuring minimising sector- informal the in for those to cater developing packages creatively resourcing domestic-based on working is government The Government. teamworkand betweenthe Ministryand MoHCC Local of partnership through public led construction be works will walks for more10km to than accesshealthcare. The CA, DHEandHealthfacilityCA, staff atMbembesiclinicinMatNorthProvince 3 3 4 4 www.crownagents.com IN THIS ISSUE • • • • WORKING TOGETHER • • TO • SETTING ADDRESS THE • LOCAL NEWS SCENE CHALLENGES 8 SIDE 19 BY SIDE 11 Chirogwe: anembodiment ofteamwork inChiviDistrict Harnessing multi-stakeholder resources to address urgencies in District Health centre committee pooling together local leaders to improve road conditions inBindura Synergies inUMPto address healthfinancingchallenges Combining Strength for ACost-Effective LearningApproach Positive Collaboration – Urging change infinancialmanagement The National Steering Committee E-Recruitment Portal for Nurses /

24 22 21 20 16 14 12 8 • • • • • TEAMING UP • • FOR • • QUALITY IMPROVED PERFORMANCE WITHTHESPIRIT OFCOLLABORATION IMPROVEMENT • RECOGNIZING INDIVIDUAL EFFORTS ADDSUPTO GREAT TEAMWORK • • • • RBF IsAboutTeamwork -Umguza If You Want to GoFar, GoTogether- Zvimba United We Stand, DividedWe Fall -Mutasa Everybody hasavoice worth hearing-Guruve Strengthening HealthFacility Management Through Cooperation- Seke Evidence ofGoodTeamwork at SotiSource RHCIn Passion LedUsHere- The BeautyofTeam Spirit–Mount Darwin Levels ofTeamwork WithintheRBFProgramme- The Story ofHolyCross Mission–Chirumanzu district Individual efforts addup to achieve Universal HealthCoverage A Celebration of Teamwork Acknowledging theteam behindthescene Collective Efforts and Top Performers Recognition A Tool for Equitable Rewarding: TheStaff Incentive Calculator 37

54 27 42 41 40 38 33 32 30 28 43 45 46 52 50 48 5 5 LIST OF ACRONYMS / FROM THE EDITOR /

ARV Anti-Retroviral On 12 December 2012, You will learn about the great collaborative effort undertaken CA Crown Agents the United Nations at national, provincial and district levels by MoHCC and CBO Community-based organisation General Assembly (UNGA) various other government entities, as well as community CSS Client Satisfaction Survey unanimously endorsed a representatives, to improve and maintain accessibility to DA District Accountant resolution urging countries to quality care. DHE District Health Executive accelerate progress towards DMO District Medical Officer Universal Health Coverage Discover how external parties are working together with DNO District Nursing Officer (UHC) - the idea that everyone, MoHCC in improving the non-health determinants that affect DSC District Steering Committee everywhere should have access health facilities’ operations and ultimately the health status of HCC Health Centre Committee to quality, affordable health the community. HDF Health Development Fund care – as an essential priority HF Health Facility for international development. In a few days, we, governments Observe how a healthy and constructive relationship with HIV Human Immunodeficiency Virus and development organizations, will be celebrating one of the District Health Executives (DHE) can transform the performance MoHCC Ministry of Health and Child Care most mediatized UN days! of health facilities. NCD Non-Communicable Diseases NIC Nurse In Charge It is a renewed opportunity for all stakeholders in the health We invite you to dive into the handpicked stories from all NPA National Purchasing Agency sector to share impressive achievements, reflect on challenges corners of the country and see for yourself that teamwork is NSC National Steering Committee and showcase latest technologies, practical solutions, and now widespread across clinics and hospitals. Health workers OPD Outpatients Department innovative financing tools aimed at improving access to quality team up to deliver quality healthcare and ensure accurate PCU Programme Coordinating Unit care. statistics are available to appreciate progress in accessibility. PHE Provincial Health Executive And this does not stop at the purchased RBF indicators; it’s PHFO Provincial Health Field Officer It is also a renewed opportunity to provide a voice on behalf of applied to the full package of services provided. QSS Quality Support and Supervision the millions of people still waiting to access their basic universal RBF Results-Based Financing human right to healthcare and to remind the world that we Teamwork deserves to be acclaimed, but let’s not forget to RDC Rural District Council must ‘KEEP THE PROMISE’. value each individual contribution, and celebrate those who RHC Rural Health Clinics excel, including those active behind the scenes. RMNSH Reproductive, Maternal, New-born and Child health Furthermore, it is an opportunity to share the stories of ardent SICC Sister in Charge Community civil servants in harnessing the RBF programme and SOP Standard Operating Procedures WORKING TOGETHER to keep the promise of providing quality On behalf of Crown Agents and the UHC Universal Health Coverage health care to millions of Zimbabweans each month, despite editorial team, I would like to wish all UMP Uzumba Maramba Pfungwe the challenging socio-economic context. health workers and our dear readers a UNDP United Nations Development Programme Merry Christmas and a healthy 2020! UNGA United Nation General Assembly In this edition, we will take a closer look at how the RBF VHW Village Health Worker programme embraces teamwork and collaboration at each ZESA Zimbabwe Electricity Supply Authority level of the Zimbabwe health system , and how it contributes to Marie-Jeanne Offosse, Team leader of RBF and HRHRS 6 fast-tracking UHC. 7 8 8 www.crownagents.com departments aswell as collaboration withacademia. successfulof teamworking Ministry within Health of fruit the is portal recruitment digital much-awaited This placements. provideand toopportunity equal nursesfor looking introducingof the portal tois more bring transparency e-recruitment portal for nurses to apply for jobs. The goal In October year, this the government introducedthe NURSES E-RECRUITMENT PORTAL FOR NEWS / available inotherprovinces around the country. that in addition to Mashonaland the nursing portal will be The MinisterCare Child of Health and has announced with theright skills. corruption. for and scope faster any Furthermore, health facilities will be provided with nurses eliminate be will to system expected the is recruitment Nursing 9 9 10 10 www.crownagents.com 1 SIDE BY SIDE SETTING THE SCENE 11 11 12 www.crownagents.com of Finance and Economic and Finance of Development, theMinistry of from officials relevant MoHCC, provincial including medical directors, of Ministry composed is It Zimbabwe. thatbody oversees the overallgovernance RBFin of the highest Resultsmaking Health policy in Based Financing is (NSC) Committee Steering National The COMMITTEE THE NATIONAL STEERING of mandate. out its carry experiences effectively to sector health and Zimbabwe the knowledge the expertise, possesses and, requisite multi-sectoral is NSC the such As NSC. is supported byof donors a pool isnowpart ofthe also represented. are organizations non-governmental international and (Crown agents Agents and Program purchasing Coordination Unit), donors, and local national two the addition, Harareand and departments.Health City In Housing, National and Works Public Government, Local The Health Development Health The which (HDF), Fund emphasis on Reproductive Maternal Newborn and Child and Newborn Maternal Reproductive on emphasis coveringissues priority health overallburden,disease and programmethe RBF focusits widened has to target key Currently considerations. equity and services of package design issuessuchasindicators,on basic minimum provides committee strategic The directionZimbabwe. of communitiesvulnerable urban ruraland and poor mostly strengthenordertosystem, in health the particular for in them into the RBF design and implementation framework, factors and determinants economic asgeo- and political social, such outcomes, health affect that factors key considers NSC The MoHCC. the of Secretary Permanent The Committee reports to and receives guidance from the Ministry ofHealth andChildCare Chief Director Preventive Services Dr. Gibson Mhlanga I thankyou. and wideto share andlearnfrom ourexperiences. programme is a beacon that has attracted visitors from far Zimbabwe RBF programme since its inception. Indeed, the the strong dedication of all who have been involved in the As the Chair of the NSC, I would like to thank and appreciate nutrition andHIV/AIDS andtuberculosis amongothers. (NCDs), Diseases Non-Communicable (RMNCH), Health 13 14 www.crownagents.com

to ensure qualityservices. better a gained appreciation of the inputs and has processes that are required Department Finance MoHCC the offices, health and provincial to district levels facilities health from process, administrative RBF in involvement being implemented across departments. Throughits with MoHCCknowing that checks andbalances are goals, set achieve to effectively confidence”work can team [MoHCC] the that “them it gives as collaboration Ms Machamire, Director,Finance MoHCC forall is this National Purchasing Agencies (NPA). RBF and MoHCC collaboration between the of result a as improvedgreatly has planning Policypartners. its with as well as MoHCC within spread has collaboration Positive MANAGEMENT URGING CHANGE IN FINANCIAL POSITIVE COLLABORATION - that ourdata corresponds withthat at Crown Agents.” accurately, and timely and done are activities ensuring in lead the take can we Now, reporting. and management financial in changes urged has collaboration positive this Concluding Ms Machamire says proudly: “I am certain that accountability throughout thehealthsystem. Toher, thesenewindicators RBF certainly will strengthen on advise indicators that can beincorporated into theprogramme. and MoHCC-PCU with work to Department She proudlyhighlights for theopportunity theFinance on health visibility better has expenditure data at sub-national level”. a funds is of There reporting strengthened. and usage the Department, support mutual the “Through between Crown Agents andtheMoHCCFinance says, Machamire Ms arise, are tackled by bothteams involved. the solutions, and making programme cansmoothly. run way,This challenges that decision NPA the in role a fromthose theGovernmentZimbabwe. of By playing includes This receive. facilities health the that resources the useofRBFresources now is and to being applied all for practice best accountability, spread has programme the into incorporated be can that practices management foropportunity The toNPAMoHCC the guide financial on ofRBFactivities. and supervision Department to have a more prominent rolethe support in with Crown Agents.has allowed Inturnthis theFinance DepartmentFinance to theopportunity worksynergy in the given has Programme, RBF the under manual, HSF ofthe review The recent dark.” the in often were collaboration, they this to “prior that notes Machamire Ms Mberengwa OperationalPlanning meeting 15 15 16 www.crownagents.com the accounting assistants are able to complete the to complete for guidance. able are acknowledgement ofreceiptfrom funds of the video using assistants accounting the In the event that the District Accountant is unavailable, errorand acknowledgingfunds RBF rates are goingdown. helped theaccountants to grasprequirements thebasic for fromwith input funds district accountants. Thetoolhas illustrates the process ofacknowledging the received RBF video that an e-learning MoHCC, the with collaboration in developed, has Agents Crown time, given cost-any at effectively accountants more reach cost-effectively to order In still needed to address the remaining grey areas. trainings, are but refresher of sessions series afternoted the were conducted for accountantsSome improvements . were management financial RBF on workshops building capacity province-based challenges, noted the address to order In not signed anddate stamped. were that forms submitted and acknowledged, being amounts incorrect facilities, health some of omission filing, errors, incorrect transposition form included that challenges of theprocessbeginning accountants all experiencedof lots the At supervision. their under facilities health along the all respectively, with earnings offices health provincial and Districtprovincial and accountants tohad report district on the DMOasAccounting Officer for the district. needed to ensure accountability of the disbursedby funds 2016 rolledand it outto districtswas 2017. This January in December in form funds’ of receipt of ‘acknowledgement Crownwith Agents (CA)worked togetherdeveloping in the collaboration in (MoHCC) Care Child and Health of Ministry EFFECTIVE LEARNING APPROACH COMBINING STRENGTH FOR A COST - is accessible throughout thecountry.” contentdigital and e-training the so sites, 184 of gap the local internet service providers (ISPs). We andour intend to bridge UNDP through Fund Global with collaboration our to thanks internet, to connected facilities health 350 easily.have Wecontent e-learning the access rate toworkers dispersion health allows which Mobile high very arises. is workers health need among the as future in made already videos have more produce will and kind, this of we videos several programme, RBF the Within effective. is cost have it and initiative we this from derived benefit as the seen same also the do are to We partners our users. encouraging the by guidelines documented of this appreciation enhance to feelused be can mode we voice in tool and uses MoHCC that (SOPs) Operating Procedures Standard numerous are There programme. the RBF to be restricted not should innovation this feel workshops for the provincial and district accountants. We for training conduct staff expensesto Agents Crown and MOHCC both reduce consequently will tool e-learning h rlig u o this of out rolling The resources. e-learning of the towards resistance a lot anticipated we because humbling was experience “This Deputy Director ICT Mr Trymore Chaurura, MrW. Chisvusva, District Accountant for Hurungwe users andissecured(itcan’t beedited).” all to accessible universally is it used, as YouTube, dissemination of method the The visual component of the resource has made it easy to grasp. I particularly like have been simplified and well demonstrated, leaving little room for discrepancies. by developed Crown Agents. resources In these clips, the steps thee-learning to be followed when acknowledging funds from immensely benefitted have “We 17 18 18 18 www.crownagents.com 2 ADDRESS LOCAL CHALLENGES WORKING TOGETHER TO 19 19 20 20 www.crownagents.com health issues. of other stakeholdersinclusion the district within the in home theimportanceteamwork of led tohas this and the brought has DHE the by conducted Meetings facilities. all the district was notimproving terms in of careof quality at two peopleoutofanexpected groupAs a result,of six. exercises and supervisions wouldbe conducted by one or evidence ofteamwork among DHEmembers, as support other local and little was there introduced was RBF stakeholders.Before Affairs ofHome Ministry (DA), Office District Council (RDC) officials, the District Administrators’ Rural members, DHE between communication improved facilities. Teamwork of verification the in role vital a play Maramba Uzumba Pfungwe (UMP) District. Within the RBF program the DHE the to relief financial brought RBF HEALTH FINANCING CHALLENGES SYNERGIES IN UMP TO ADDRESS DHEmappingoutthewayforward for theirdistrict programme in otherdistricts. the benefit of their health facilities is reflective across the for together collaborators coming key of integration This even after theprogramme ends. continue will principles because sustainability to leads outreachteamworkof a sign is which missions this and goals.RDC can now provide transportto for theMoHCC vehicles, towardsthe achievement certain of health quality,other ministries with resources sharing like importance of teamwork has greatly improved healthcare thatare often chaired officials. RDC by ofthe Recognition MoHCC now attends regular district social service meetings and identify areas for strengthening. providesalso This toopportunity an review performances wherehealth- meetings related issuesare addressed and ways forward mapped. quarterly conducts officials chiefs, headmen, pastorsrelevant and districthealth and including (DSC), Committee Steering District Currently,a roadunderconstruction Currently Matepatepa Road connecting Bindura provincial Bindura also have Funds renovation. under connecting is clinics rural five to hospital Road Matepatepa Currently Development Fund to ensure that road conditions improve. it wasand the DSC agreed thatwork theRDCwill theDistrictwith had become a challenge. Theissuewas brought forward through areas. Roads were neglected for some time and ambulance access resettlement in those especially patients, of referral the affects have and Committee frequently expressed concernsroadthe bad about network that Steering District represented are HCCs contributions to support road reconstruction. at theforefrontsourcingand people mobilising of community The Health Centre Committees (HCC) in have been ROAD CONDITIONS IN BINDURA TOGETHER LOCAL LEADERS TO IMPROVE HEALTH CENTRE COMMITTEE BRINGING thus saving more lives. more accessible, making referral ofpatients faster andsafer and now are clinics and improved has district the across condition by sheer will to see their communities develop. The general road development. These arebodies made up ofvolunteers driven recognises policy health public as statutoryHCCs for bodies communityof thepurposes 2018 the mind, in this With communities at large. for developments at health centres, but inthe development of andother clinics only pivotal, not been HCCs have The institutions. service public linking of roads repair the prioritised have programme, work’ ‘food for the collaboration with in HCCs, The has beenrepaired andpartofittarred. connectswhich Bindura hospital to theremainingeight clinics, Road, Domboshava addition, In tarred. is road the of part that been madeavailablefrom the central government toensure 21 21 HARNESSING MULTI STAKEHOLDER Firstly, the committee has successfully engaged ZESA far, surveys conducted in the affected areas show that the from looking for transport funds as it was arranged that RESOURCES TO ADDRESS URGENCIES officials in tracking down the transformer that was improvement of water supplies will eventually benefit the the supplies were to be conveyed to the health facility at IN INSIZA DISTRICT removed from the Gwatemba area. Water supplies to communities surrounding the health facilities. their due time. the health facility and farming community of Gwatemba were seriously affected by the lack of the transformer. The Through Local Government members, the Committee has Finally, effective multi-sectoral teamwork was exhibited The District Steering Committee is a multi-stakeholder transformer had been removed for repairs and had not also lobbied for the sensitization of all new Councillors on during the Measles and Rubella campaign, where different forum that has a vital oversight and advisory role. The been returned for two years, but after the engagement of Ward Health during their training, to ensure that HCCs are departments contributed their vehicles for use to ensure Insiza DSC has been at the forefront of addressing critical ZESA officials following the committee’s collective efforts, adequately supported by their Councillors and that the that targets were achieved. issues that hinder RBF programme implementation. This proper advice on the course of action needed to return community is satisfactorily engaged on health matters. team’s collaboration has been so effective that in addition the transformer was implemented. ZESA officials have The teamwork among members from different sectors in to health issues their meetings cover other matters been supportive in creating new electrical connections, Furthermore, the social welfare members have been able the province has improved health service delivery. This in involving stakeholders within the committee. The effects which have been long outstanding, to health facilities. to present the challenges they encounter while caring for turn has manifested in improved economic activity from of this committee are being felt within all the wards of the orphans and vulnerable children. In August, there was an a health workforce. This also positively correlates with district. In addition, through exemplary teamwork, the District incident where these children could not access ARVs due improved literacy levels as children in the communities Steering Committee has also been advocating for the to these being unavailable at their local health facilities. are now able to attend class with little to no disruption Here are some of the positive effects that have come drilling of boreholes pertaining to health facilities with But thanks to collective team efforts and engagement by due to ill health. about as a result of the committee’s great teamwork that water challenges through the Local Government members the District Steering Committee, the children were saved stretches beyond the perimeter of the health facilities of the committee. Although none have been drilled thus within the district.

DMO chairing Insiza DSC meeting Insiza DSC team 22 23 24 www.crownagents.com efforts. RBF gave themtheplatform tojoin efforts. mothers’ waiting home couldnot be constructed with individual only the hardships, economic the to Due members leaders including gaveto theirsupport theidea. Following encouragement from theHCC, community were and clinic the to desperately inneedofa secure waiting area. 15km than more were travelling mothers Expectant home. mothers’ waiting a of the construction in community the of mobilisation the been has action in teamwork of exampleoutstanding An influence and respect, they have inthe community. district becausemembers theHCC madegoodthe use of of teamworkingthe spirit expandedthroughout the Sondo, Mr clinic, the atCharge in Nurse the toAccording so thereafter. do to continued have they teamwork, through subsidies Chirogwe healthworkers wereto able boost their Initially, community. Chirogwe whole the across spread teamworkThe dynamic began which athas theclinic proponents have revived thistradition inChirogwe. RBF “Zunderamambo”. call Zimbabweans the commongood of thecommunity through a concept and community participation. Communities Zimbabwein used to work for of teamwork tradition long-forgotten adventThe districtChivi in RBF of revitalised has a TEAM WORK IN CHIROGWE: AN EMBODIMENT OF RBF,” hesaid.“Pamberi neRBF!(forward with RBF!).” in that‘I wish programmes all couldof the lines along run RBF from gleaned concepts developmental projects. utilizing now are communities excellence”.The health of cathedral a into clinic our turned has “RBF that stated He development. sustainable forcatalyst the been has RBF Gwanongodza, Accordingto thelocal Ward councillorMr Ephraim boreholes intheward. tocaterswhich a fund for themaintenancerepair and of USD$1 contributed has member family each all, of good forthe participation of sentiment the With boreholes. repairingtheir roads resourcespooling and torepair of teamworkThe spirit seen the communityhas also constructed inrecord time. was shelter mother waiting the Accordingly, materials. allbuilding from buy to money fund use development constituency would the Parliament of Member The the community wouldcontribute riversand. pit and was agreed It that RBFsubsidieswould be usedto pay builders and meetings. Committee Steering District through input his gave Parliament of Member local The HCC planningmeeting inChivi district 25 25 26 26 www.crownagents.com 3 THE SPIRIT OF COLLABORATION IMPROVED PERFORMANCE WITH 27 27 28 www.crownagents.com - CHIRUMANZU DISTRICT s h fclt’ erig rpe b coe o USD$200 to close by dropped potential, earning of their facility’s the as reflective not was HDF-RBF under of2018 quarters two first the Cross, Holy forHowever, earnings surpassinganaverage ofUSD$5000. 11% by increase an seen have programme HDF-RBF the However,financing. input-based in enrolled the hospitals under of $4,500 amount flat a receiving was hospitals, other like Cross, Holy programme, HDF-RBF the Before programme inMidlandsProvince. Chirumanzu in district isoneof13 hospitals contracted undertheRBF Mission Cross Holy hospitals. cover to extended was programme HDF-RBF the 2018, January In THE STORY OF HOLY CROSS MISSION Mr Pomerai, DeputyDirector QualityAssurance MoHCC areas thatrequirestrengthening”. clinic andhospital staff; wherenecessary they mentor themin embark onquarterly visitswherethey meet supportsupervision way to maximize onRBFsubsidies. DHEsandPHEsteams now drastic changeinmindset, as collaboration istheonly effective Withtheintroduction oftheRBF programme,therehasbeena implementation werefragmented. andsupportsupervision coordination ofactivitiesneeded tobe strengthenedasprojects Provincial Healthoffices wasnot systematic. Integration and Before theRBFprogramme,teamwork atDistrict and report reflecting on areas that need improvement. The need improvement. that on areas reflecting report After supervision each hospital receives a detailed feedback process. learning a as but exercise finding fault as it view longer no seriously. They PHE the from feedback take now staff hospital supervision, managementsupport quality and the After PHE. and DHE HCC, departments, staff hospital now is Teamwork better. improvedstakeholders.all among all These include the for changed has Cross Holy of story the DHE, and PHE from efforts many After with otherdepartments. coordination limited with silo operational an as working as was limited teams departments were workingEach silos. in department was other with Coordination this. for reason major a was teamwork of Lack quarter. per Crown Agents collaborating Director withMinistry ICT HCC, the team has managed to improve infrastructure and and maximizing their earnings. Working together with the care of quality their improving into effort more put now Programme, staff RBF the of benefits the realised Having areas. registers. Improvedscores quality have resultedthese in in documentation proper and controlcommittees quality nowbeen implemented through teamwork, such asthepresence of have but neglected being were actioned be to resource additional require not did that areas Some board. andissues on taken are recommendations and discussed are raised each department with shared are findings district teams to ensure qualityisdelivered. and provincial the with closely working are staff Hospital of teamwork has been fostered among allstakeholders. the generalappearance the facility. of As aresult, thespirit QUALITY SCORE EARNINGS 29 29 30 30 www.crownagents.com involvement. acknowledging local leadershipand thecommunity the key playersthe healthdelivery in system as well as involves it as ideal is model This members. PHE and DHE bythe teamworkis underpinned between the health facility staff members, HCC, (RBF) financing Results-based DISTRICT RBF PROGRAMME - MBERENGWA LEVELS OF TEAM WORK WITHIN THE quality assessment.quality They have developedof the habit RBF programme and know what isexpectedtheir during Health facility staff members are now well informed of the the integration ofactivities. allowed has department each meetings from representatives with planning Now, and supervision. management regular drug however for go would pharmacist the go tothe TBprogramme, support the following and week would DEHO the example, For activities. individual their request avehicle,driverand fuel order in to carry out Before RBF was introduced, DHEmembers wouldeach compilation and presentation. This teamwork has indicators. teamwork quality and quantity of This improvement the in culminated presentation. and of statistical compilation improvement the in result meetings The members. DHE and Department Information Health with the along representative, a sends facility health Each month. every held is meeting nurses’ and validation Data together before delegating individual tasks. indicatorsquality review and failures theirsuccess and conducting feedback meetings. Here, they go through the before beingsubmitted to theLPU. Officer, Medical District the by endorsed and scrutiny for DHE the to brought are plans operational the complete, Once transparency. in greater resulting facilities, the by held is procurement meeting evaluation a procuring, and plans the executing When implemented. be to projects theyand agree discuss facilityon health requirements and management attend and operational in charge planning training. As a nurses team, and Committee Centre Health HCC andfacility staff meeting 31 31 32 32 DNO andhealth facility staff checking registers www.crownagents.com tanet Bfr te rgam tee a notmuch was there programme the Before attainment. between communication departments, and we are more focused ongoal improved and meetings more are There team spirit. availability.We have increased autonomyenhanced and working environment isconducivethere and resource is our supervisors; from support get we incentives; staff as are acknowledged efforts our because motivated are We need to provide we are qualityservices, ahappy team. due todue free the and services Despite increased workload motivation. low and burnout has programme resuscitated usfrom both RBF “The MOUNT DARWIN TEAM SPIRIT - THE BEAUTY OF Ishmael Kapiringu Care (Primary Nurse) gap identification andbridging.” carried out strategically. As a result, there is performance from the DHE’s visits. Support and supervision visits are now We are motivated by the scores and the immediate feedback team spiritwhichpromotes highsubsidy earning. efficiently and supportive. being We have developed therapeutic long-lasting now integrated through areare DHEvisits RBF planning. encouraging Programmes programme. and support in skills have supervision through been enhanced the RBF DHE’s our that see clearly can We each otherfeedback timeously. give and together data analyse can we Now health department. environmental and staff nursing between liaising children under five-years-old to take them to the facility the to them take to five-years-old under children As a result,was theschool ableto persuade parents of services. the communitymobilise to come tofacility thehealth for primary Soti Source and to encouraged were HCC parties headteacher.These school’s as VHWs, such parties external include to togo seeking by advice DHE’s the motivated beyond sufficiently were staff facility Health and were spurred onto pulltogether. was allocated anindicator that they were responsiblefor Charge. member staff dedicatedEach in Nurse the by left need for the health workers to work together to fill the gap The DHEwhovisited the facility realised that there was a amber category. inthe them placed classification verification risk-based setbacks. scoresQuality dropped by 11pointsthe and retirement, began followingexperience to her the facility the managementheld the facility of her shoulders.on But who Charge in Nurse devoted a had volumes, its to due June 2018 Soti Source RHC, one of the low-income earners The key tothese improvements good is teamwork. Before its qualityscore. toleading schools, and more resourcesincreasean and in collaboration betweencommunity, the workers health its The RBFprogramme fosteredhas astrongof spirit times. recent in facility improved most the as emerged has RHC Source Soti District, Gutu in facilities 28 of One SOTI SOURCE RHC IN GUTU DISTRICT EVIDENCE OF GOOD TEAMWORK AT r big drse a I e rglr problem-solving regular meetings”. see I as addressed being are I amsureCSS. during that thefew remainingcomplaints seeing great changethe feedback in theclients are giving am “I says CBO, clinic the Gumindoga, Mr Furthermore, expected to beapartofthedecision-makingprocess”. never [he] as programme RBF the “appreciated he that example, thegeneral Shonhe, athand thefacility, says a strongunderstanding the valueof teamwork.of For andhave hard working to continue motivated are staff retired satisfaction has increased. With the job rise in the team’s staff incentives, the and of available now are leadership Resources nurse. the under achieved score increase 20% a scorequality in a year, within exceeding in thehighest resulted teamwork improved This beyond theRBFrequirements. for malnutrition and other ailments. This intervention was screened and weighed were under-fives children where RHC staff members started to conduct healthy school visits Furthermore, immunizations. and monitoring growth for Retirement Score before NIC Quality Score Q12018to Q32019 Retirement ofNIC 91.5% 90.7% 79% 89.4% 95.3% 96.4% Retirement Score after NIC SCORE TEAM WORK 96.6% 33 34 34 www.crownagents.com success ofhealth facilities. It is evident that teamwork and dedication are crucial to the will lead to increased earnings to tackle financial challenges. can go agreat distance and,throughthe RBFprogramme, effortsnon-monetary these understandingthat an is There the experience at thefacilities intheirdistrict. on their feedback hear and patients to talk to visits QSS his during time extra takes he preaches he what practising By be thefocal point ofeverything thefacilityworks towards. quality healthcare. He acknowledges that patient care must DMO,The DrMakonesepassionate is the provision about of as having statistically accurate data, inthe green category. 67% of health facilities assessment, in are classified the biannual in initiative their of result a As the standard ofhealthfacilities. raising to dedication their of evidence is This programme. forthe not a requirement is which verification, level first Umzingwane DHEs went the extra mile to double-check the more positive to yield results. order in critical is teamworking good hence incentives, more to up add losses, the Fewer when they are documenting and reporting ontheir data. staff incentives, losses minimise to bid 25% a in team a as work facilities health the of introduction the Following or andplanning structural indicators). management clinical, thematic (namely 3 the sections under well performing be not may they workershealth each otherthegreywith discuss areas where by DHE have resultedan improvement in team in as spirit conducted visits supervision quarterly the Umzingwane,At PASSION LED US HERE - UMZINGWANE DMO checkingpatient 35 35 36 36 www.crownagents.com 4 IMPROVEMENT TEAMING UP FOR QUALITY 37 37 38 www.crownagents.com between 75and90percent. givenhas This riseto theimprovementscoresquality in communication. improved further has visits supervision a quarterlythe DHEon with and support during basis the interaction In addition, departments. different the between relationships the of understanding improve to toclinics thedistrict. Aclearorganogram was designed the from structures communication redefine helped RBF well asboosting the staff morale. as facility’searnings, the improved has immediately. This meetings were implemented where errors were corrected on the clinic’s earnings the DNO took action. Monthly data had reporting data inaccurate implications the Realising were submitted ontimedespite reporting errors. documents to ensuring given was consideration not corresponddid documents.with the original More reporting. data There were cases where some datathe registers on accurate of importance the regarding Before RBF,Seke in district there was aknowledge gap the healthfacility inorderto increasetheirearnings. a point-based system. Thispromotes cooperation within assessments, unlike thequantity indicators thatworkon between activitiesisrequired tosucceed inthequality linked to earnings.Thisisbecause integration RBF isnow puttingmoreemphasisonqualityattributes COOPERATION MANAGEMENT THROUGH STRENGTHENING HEALTH FACILITY Edmore Mutizwa, GeneralHand. subsidies” in thestructural score whichleadsto usgetting more proudofmy“I amvery contribution asitplaysa key role Ellen Dhliwayo, NurseinCharge framework.” relationships between the staff that exceed theRBF staff. Theimproved attitudehasalsoled to stronger “Overall, responsibilitiesarenow sharedequallyamongst DNO conducting quality supportsupervision 39 39 40 40

CBO givingfeedback ata health facility meeting www.crownagents.com staff members failing to reach theirperformance peak. led to This motivation. lacked and under-appreciated were members staff the said was it and clinic, the at development differenttoBvochoraat due little There clinic challenges. was Before the launch of RBF, there was poor collaborative working “EVERYBODY HAS A VOICE WORTH HEARING” - GURUVE Nurse Webster Care Gunja,Primary well asthroughHCCs.” conductedsurveys by CBOsas patient tracer andsatisfaction is sought throughregular Inaddition, services. feedback in improving thequalityof the roleofcommunity voice “As staff memberswerecognize them into theirregular meetings. have incorporated clinic as Bandimba such facilities, health themselves. They play a pivotal role, somuchthat many patients the from feedback constructive provide who CBOs tothe programme. For that reason, there are designated brings participation community that insight the values RBF the HCCmanaged to improve community participation. solution. Moreover, this kind of teamwork through the help of arose. The that team were the problems able to on discuss and find the best perspective possible a unique offer to chance team Each a responsibilitymember had to contribute the and equally reporting. data in accuracy improved showing In the2ndquarterhavenot did 2019, of the clinic any losses, to theHealthInformation Officer at district level. submitting before data analysing month, every of end the at down sitting andquality members all through achieved was This results scores. better achieve to wanting clinic the of departments all with competitive environment a created RBF to RBF for the way it has facilitated attitude changewithin clinicworkers. attitude facilitated has it way the for RBF to attitudes who now work diligently, have theysaid are indebted staff, staff The large. at work shaping their to and clients, in towards greatly helps feedback Clients’ clients. their to care of quality the enhancing playedalso apivotalrole improvingin teamwork and has CBOs the from get staff clinic that feedback The team. support andsupervision also aided in implementing recommendations from the day. each of has end registers It of the updating at and ithas way the for RBFencouraged staffon meetings, routine follow-ups staff, applauds NIC Augustine St to lackofownership andcare. programme,error and losses high had it but rates due potential to earn highsubsidies at the of the beginning few checks and validations in place. The clinic had great were either under- or Statistics over-reported as there were inadequately. very done was consolidation and data of Documentation deliveries. child quality poor in resulted this and with, work to who about selective and one another. Before RBF was introduced, the conduct staff were with collaborate to willing staff now are staff of improved members also has Teamwork and consolidation of records. documentation care, patient of quality the improve to RBF has made it possible for clinic staff to work as a team clinic staff inMutasa district. mission stand, Augustine St. for we true is “united fall”.This we divided says, that adage old an is There “UNITED WE STAND, DIVIDED WE FALL” - MUTASA NIC comforting patient Statistics meeting 41 41 42 Nurses checking partograph 42

www.crownagents.comsuch asthequantities and how toimprove onthese. statistics at look We performed. have we how at look a have to together down sit HCC the and members staff month every of end the at and work to eager more now are members Staff departments soasto have better results. different the in team a as work to together coming members staffto led then This facility. our for more earn to us enable programme we learnedthat havingscoresquality high would each personand was their own doing Due to thing. theRBF a po coordination poor was There staff. of members much teamwork between programme, there was not that before the RBF back, I recallWhen Ilook “IF YOU WANT YOU WANT “IF TOGETHER” FAR,TO GO GO Sister Madondo(SICC) since we were connecting as team players notasindividuals. to 13deliveries per monthsomehow and reduced ourburden 10 to figures our boosted This responsibility exist. previously a didn’t which - experience weekly or monthly the share laterand issues, with focaldealing personthe as area OPD or rotational element. This meant that one would cover maternity RBF we developed the concept of specialization, though with a We usedtoconduct two to three deliveries amonthwith but and effectiveness. togetherness brought RBF individualism. unproductive usual toengage, interdependence and developedour of place in started we slowly plan, operational the drafted we time the By together. activities our out lay and plan, together, come to had we meaning plan, operational an it with brought RBF this purpose.” for table a round at sit and participate statistics members staff forall when day one Allocate mistakes. minimise you that so statistics doing when especially team a as together work should towardsworktoYou goal.common a getstaffALL incentives and differences aside put and together come staff to all requires RBF The message given by PHFO Trish was that “RBF is about teamwork; mentorship to restore teamwork was emphasisedwithinHFs. responsibility,and there was aneedtoimprove teamwork. Job errors. This the allocateduties to good is it while revealedthat,response of for kind todo was responsible was allocated month, that who for statistics nurse, particular a that was given register, source explanation the the and statistics T5 clinic the in a lackofteamwork. For example, when discrepancies were noted At the start of the programme, it was observable that there was have increased dramatically. effectiveness and impact their towards a this, understood district in Umguza staff Once RBF. of together guideline fundamental a andworking is goal common aside differences Putting “RBF IS ABOUT TEAMWORK” - UMGUZA CBO andclinicstaff working together enjoy workingtogether asateam atmost clinics. and clinic staff, a bridge which existed before. CBOs and clinic staff earnings have increased aswell asqualityscores just in RBF but also in the other programmes. In addition, facility impact that teamwork creates. It generates better outcomes not facilityno red in the province. in stunningis This evidence the of shifted from red category to amber and green. Currently there is staff. HFs of that number increase the an in by evidenced is This HF amongst noted was attitude of change a on, went time As h cmuiy members community the between gap the bridged has RBF that shows forward.” This we ways and discuss feedback CSS giving when them with l sit staff. clinic the clinic of part now am “l Mbembesi commented, CBO a at Mpofu Fungai 43 43 44 44 www.crownagents.com 5 ADDS UP TO GREAT TEAMWORK RECOGNIZING INDIVIDUAL EFFORTS 45 45 46 www.crownagents.com RBF provides incentives to increase the motivation of motivation the increase to incentives provides RBF is what RBF is promoting. This is, by definition, teamwork. efficient way effective and most the in healthcare quality a healthfacilityof to achieve thecommongoal of providing universal healthcoverage. coincidentally, theyaddress also therequirementsof are used, facility. Not each at quality the determine collectively, to surveys satisfaction client and planning and quality the for 60% indicators. Structure, above clinical management, management that scores the condition facility on health the incentives, facility staff health are the subsidies of 25% coverage. health universal towards to work Zimbabwe, in facilities health rural to assistance financial providing by factors, these address to aims (RBF) programme Financing Results-Based The quality healthfacilities). to access easy capacity, and conditions living education, as (such clinical include motivated staff and actions to address social determinants requirements services. health Additional seeking after hardship financial from protectspatients This incurred.costs system the coverto vibranta systemhealth mustfinancing supported a bybe any community. in reduction poverty and development this, achieve To sustainable for critical is and Zimbabwe, including countries, many in reform health in goal major a become has This hardship. financial of risk the without services, health quality needed to access has population Universal health coverage is defined as ensuring an entire COVERAGE TO ACHIEVE UNIVERSAL HEALTH INDIVIDUAL EFFORTS ADD UP A collaborative effort by a group of independent members irrespective of their position. As they contribute efficiently, for theirperformancefacilitythe health within team, accountable and motivated feels everyone is result The and numberofabsences documented. through numberofhours worked, extra hours worked, calculated is This contribution. individual their on based staff of member each to distributed are incentives staff recognizes RBF this and goes further to be acknowledged. reward individuals. The must contributions individual’s facilitythe health each member of team, the valuean of delivery atservice theirfacility. To showcase the best of facility havewill health knowledge unique that skills and contribute to the in effective at staff of a key member Each teamwork. is qualities individual on Emphasis the service delivery.the service each personpushes to contribute tothe improvement of the quality threshold is achieved to receive incentives. This perform their duties must to a staff high standard so of that collectively, member Each group. the to performance individual’s each for accountability in increase an to due individuals to motivate teamwork effective encourages access to healthcare. quality RBFcapitalisesand on and improve proficiency clinical the to contribute staff, Immunization visit services improves,services addressingdeterminant thissocial facilityaccomplishes the accesstothis adequate health the team candeliver greater Ifeach service. health quality health coverage. in effectively their respective areas, a contributing community can achieve universal staff of member individual each by created foundation strong the to Due health. of 47 47 48 www.crownagents.com in thequarter. are the numberofhours worked, contracted andextra, rewardingwho goindividuals above and beyond.These they perform. Flexibleparameters provide themeansfor Every workera right has to fair pay for thework that the total incentives for their facilities. of percentage same the receive will Charge in Nurses all the constructswithin the programme. of means that This seniority on based is Allowance, fixed Responsibility The putin who more to receive greater rewards. individuals allow that parameters flexible and hierarchy, the within responsibilities job on based parameters, fixed are There below. shown as incentives productivity increase to help commitment.and There are twoways tocalculate the can which valued feel staff of members result, a As outcomes. worker health improve to programme incentive staff a implements RBF THE STAFF INCENTIVE CALCULATOR A TOOL FOR EQUITABLE REWARDING: Responsibilty Allowance Senority Fixed Contracted hours Number ofWork Hours Staff Incentives Extra hours None vital activities (such as TB Coordinators and administrative out carrying key players addition, In contribution. their membersall oftheDHEreceivedamount anequal despite wereacrossequally divided members.the DHE However, incentives the Office, Health District the In be incentivized. would groups focal the only approach, this to Prior awarded respectively. parameters, everyone’s contribution is acknowledged and carries out first level verification. By factoring in the flexible that sister the - involvementdirect (iii) lastly and drivers, the as such services support - involvement Indirect (ii) contribution, no (i) are; These reward. in increasing each contributioncategorized is levelof The into three groups, individual’s an determine performance. The better to you perform, the more you earn. quarterly conducted is manager line the by appraisal Staff contribution. of level activities There are twoparts to performance individual this; and the impact the performed bythe programme.has on the individual considers factor third The Flexible Perfomance Indirect Contribution to RBF Contribution Direct Level of Quality support supervision visitinMberengwadistrict Quality support supervision verified by the district, Crown Agents counter-verifies Agents Crown Once district, of autonomy. the by asense verified providing staff, their for the incentives to calculate data staff the inputs Charge in Nurse each facilities, health the empower further To and ensures everyone isvalued. teamwork encourages incentivization to in expanded were incentives everybodyinclude that plays apartinRBF. staff equity This incentivized. this, not resolve were To scene, the behind assistants) skills andidealsare sustainable. canbe strengthened. vitalis which of All to ensure RBF Lastly, effective decision-making skills from the bottom up activity.fosteredbe this throughalso can analysisdata in developsand trust between theteam. Animprovement incentives of distribution the in transparency creates It incentives. monetary the calculating beyond go m-IC of outcomes The process. this automate to used is (m-IC), Incentive Calculator- Mobile CrownAgents,bythe called developed application mobile A data. the processes and 49 49 50 50 www.crownagents.com Willard Mutseka own smallfarming projectthatIhaven’t hadthemoney to dountil now.” earning nurseaidebecause ofit.Ihavesavedmy incentives to start up my “I wassogladto seemy hardworkwasacknowledged andI was thehighest earn higherstaff incentives. to them quarters subsequent for the in targets higher achieve collectively to Throughteamwork collaboration,and the staff aiming health is the facility at although she worked the least hours for the quarter her effort was recognized. which improve quality ofcare. Monetary rewards which homes, installingboreholes as well as green energy to procure vital medicines, constructing maternity waiting earnings of percent five seventy use can facilities Health use offacilityearnings to improve delivery. on service on autonomy given are facilities Health targets. agreed pre- meet to performance on based facilities health and level. Rewards are given tohealth workers individual ensures rewarding at facilitylevel aswell asindividual challenges bedevillingthe healthsector. TheRBFapproach approachaddressedhas worker health performance emergenceThe the Results of (RBF) Based Financing PERFORMERS RECOGNITION COLLECTIVE EFFORTS AND TOP the leastHowever, earnings. grateful sheis that worked for 64 hours for thequarter had and Rosemarythe other hand, on Machipinda the othereight nurse aidesatfacility. thehealth receive thehighestas compared earnings to to managed Afterworking he quarter, the for hours 528 for motivation. and satisfaction Mount attests that RBF has impacted on health worker District at Nyanga in Aide Hospital Mission Nurse Melleray a Mutseka Willard results andimproving qualityofcare inthehealthsector. promotedthus has RBF aperpetualculture delivering of to perform, work togetherimprove and delivery. service motivated staff has facilities health and workers health both individual for resources financial additional having of higher incentives for staff. The collective expectation of benefits of working as a team means the collective earning the health facilityscores quality thus, the clear and shared on depend will incentives Staff incentives. higher earning of achievingvision highertargetscommensurate which to and collaboration have been fostered as staff have a shared staffto perform aswell asimproving delivery. service Teamwork motivating thus workers health for conditions use offacilityearnings hasresulted improved in working are performancecoupled based autonomywith the on Nancy Sibanda efforts areacknowledged.” I couldn’t before. Iamsohappy thatmy my personallife. Ican now enjoy things positively impacted on my life, particularly “I amlost for words.These incentives have for working 528hours duringthequarter. earnings highest the receiving after ecstatic Paul’s St at HospitalMission DistrictLupane in was Aide Nurse a Sibanda Nancy 51 51 programme run smoothly.” the making are They level. provincial and district both at Agents Crown with have we that relationship good the likeacknowledge toalso would I they know they will berewarded beautifullyafter quarter. every because working continue to motivated really are colleagues DHE other ateam,and as my way This appreciated. be should team our work of member our each therefore we on because depending me happy us, of makes This all contribution. amongst shared are subsidies now that delighted am I anything. receiving not were members supportive our but subsidies, receiving were team DHE the of members certain only Before, tangible projectsthatlamreallyproudoftoday. do to able been have I gap. the bridge to managed have they subsidies, the with but long for us sustain longer no they that extent an to inflation significantlylives better.our made have eroded by been have salaries Our Development Fund for the DHE allowances that we receive quarterly. They “My name is Dr TL Nyafesa, DMO Makoni. I would like to thank the Health 52 www.crownagents.com -Robin S.Sharma richness ofyourcontribution.” “Success isnotafunctionofthesize ofyourtitlebutthe THE SCENE ACKNOWLEDGING THE TEAM BEHIND hrfr, wud ie o hn al h partners the supporting theRBFprogrammeinZimbabwe.” all thank to like would I Therefore, I haveamorepositiveoutlookontheworkdo. I am no longer worrying about financial aspects and and hasimpacted positivelyon my productivity. mind of peace brought has It recognised. being are gesture. I really appreciate it as I feel that my efforts good a be to proved has quarter every incentives of form in rewarded am I that wage extra The district. Makoni in Hospital General at technician rehab a am I Mandishona. Primrose is name “My 53 53 54 www.crownagents.com Program management andintegration hasbeenimproved A bridgebetween thecommunity andthehealthfacilities They havebeenrefurbished, refurnished andre-stocked. Gaze uponthehealthfacilities, thatscenic appearance CBOs andHCCssupportingvoicing for thepatients A solutionthatresultsinbetter resource availability OF TEAMWORK A CELEBRATION Look atthejovial nursesandotherteam members, Community concerns, feedback, ideasareshared Constructive relationships havebeenbuilt. When itbeganthey thought itwasahoax Resulting inenhanced communication A solutionthatlinks results to finance Resources arebeing brought to light Patients too believed itwasaplay The nursesthought itwasajoke Doctors assumeditwasaskit Ever fulloftraffic toandfrom It isneitherfable norjoke IT ISREAL IT ISREAL IT ISREAL / DHEs andPHEsswarm healthfacilities inawaynever seen before By supportingandworkingatoptimum levels with staff members As wellasthemanifestation of excellent teamwork among staff Look atthatmothersmilingwithherbaby inherarms Reduced maternal mortality, enhanced childsurvival Just like water inadesertRBFisvital andprecious Sustainable goalsandactivitieshavebeenborn Ensured thattheirhealthistaken asapriority. Without RBFthatsmilewouldn’tbepossible Weston Manyika (Karanda Hospital CBO) Healthy peopledoingdayto daychores, The RBFprogramisthought provoking RBF isbetter health an RBFCBO. by authored poem this in envisioned be can RBF in teamwork of to accomplish celebration This themselves. than bigger together much something pulling of have benefit and achieved the have experienced they work the of proud are CBOs RBF ISREAL IT ISREAL 55 55 56 www.crownagents.com 57 This document was produced by Crown Agents on behalf of the Ministry of Health and Child Care. The HDF and supporting donors do not necessarily share the views expressed in this document. Responsibility for its contents rests entirely with the author.

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