MIDLANDS STATE UNIVERSITY FACULTY OF SOCIAL SCIENCES DEPARTMENT OF LOCAL GOVERNANCE STUDIES THE EFFECTIVENESS OF RESULTS BASED FINANCING IN THE PROVISION OF BETTER HEALTH SERVICES .A CASE OF RUSHINGA HEALTH INSTITUTIONS. BY MUWANIKWA TATENDA R121761X DISSERTATION SUBMITTED TO THE MIDLANDS STATE UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF A BACHELOR OF SCIENCE HONOURS DEGREE IN LOCAL GOVERNANCE STUDIES. OCTOBER 2015 i APPROVAL FORM The undersigned certify that they have read and recommend Midlands State University for acceptance, a research study entitled: “The effectiveness of Results Based Financing in the provision of better health services, a case of Rushinga health institutions” submitted by Muwanikwa Tatenda in partial fulfilment of the requirements of the Bachelor of Science Honours Degree in Local Governance Studies. Supervisor Signature …………………………….. Date…………. /…………/…………. Chairperson Signature……………………………… Date…………./…………./…………… ii RELEASE FORM NAME OF AUTHOR : MUWANIKWA TATENDA TITLE OF PROJECT : THE EFFECTIVENESS OF RESULTS BASED FINANCING IN THE PROVISION OF BETTER HEALTH SERVICES. A CASE OF RUSHINGA HEALTH INSTITUTIONS. DEGREE PROGRAMME : BACHELOR OF SCIENCE HONOURS DEGREE IN LOCAL GOVERNANCE STUDIES YEAR THIS DEGREE WAS GRANTED : 2015 Permission is hereby granted to the Midlands State University library to create duplicates of this dissertation to lend copies for private, scholarly or scientific research only. The author reserves the publication privileges. Neither the dissertation nor extensive extracts from may be printed for publication or reproduced without the author’s written permission. Signed…………………………………………………………… Date ……………………………………………………………… Permanent Address : St Paul’s Musami Hospital. P.Bag 667 Harare East Email Address : [email protected] Cell number : 0777 415 417 iii DECLARATION I, Tatenda Muwanikwa do here by declare that this research is my own creativity and that the paper of work has not been submitted to any other University undertaking the similar degree. All the sources used in the research study were acknowledged Signature………………………………. Date ………………………………… iv DEDICATION I am dedicating this research to my beloved mother, my academic sponsors, my loving sister, friends and family for enhancing the feasibility of this project. v ABSTRACT The research study focused on the effectiveness of Results Based Financing (RBF) in the provision of better services within health facilities. The main motives of this research are to examine the forms of RBF being partaken by health service providers in ensuring changes in the health sector, to identify the various challenges experienced in the implementation of RBF, to analyze the influence of RBF towards a motivated health workforce within the operating circles, to assess the extent of community participation in the implementation of RBF by health facilities, furthermore to recommend solutions to thwart the challenges experienced in rural health institutions. Methods of assessing the effectiveness of RBF were discussed in depth in the literature review phase. The study reveals the empirical evidence about the performance of RBF in an effort to curb maternal and under-fives deaths. RBF can be effectively implemented through the availability of the required resources and timely disbursement of the funds to allow early strategic planning. The results obtained from the research findings indicated that political will and commitment should be the key in ensuring the uplift of developmental reforms within rural communities. This would aid in enhancing the effectiveness of RBF in the health clinics. In this regard, related literature was critically analyzed thus different scholarly views were postulated concerning various themes identified by the researcher hence RBF was thoroughly defined, forms of RBF intended to assure changes in the health arena, issues of community participation as well as motivation of health employees to perform better were well articulated. In the research methodology section the researcher used both the qualitative and quantitative research designs. The target population of the study was 198 individuals with a sample size of 40 participants thus 18 from expecting and mothers with under-fives, 4 from the community leaders (CEO, DA and councilors), 12 from health workers and 6 from the management within the health field. Focus group discussions, questionnaires and interviews were used to acquire primary data in the research. Sampling techniques namely Stratified, Simple random sampling and purposive sampling were used to obtain information from the rightful participants. The presentation of the research findings reveals the forms of RBF used in Rushinga health facilities. The participants also unfolded the challenges that are encountered in the execution of RBF. Community participation was indicated as a critical area which need to be considered if RBF is to be effectively nailed. It was noted that employees within the health field requires motivation through motivational platforms such as early disbursement of funds and deployment of health workers in influential posts. More so it was resolved that there should effective engagement of women who are the beneficiaries of RBF in decision making on health related issues and also awareness of the health program should be fostered through awareness campaigns. vi ACKNOWLEDGEMENTS Above all things firstly my gratefulness goes to the Sovereign Lord for His divine guidance, protection and for the gift of health during my academic years at the learning institution. I could have not pulled through if it was not for Grace of the Lord. I also acknowledge the unconditional support and inspiration from my beloved mother Mrs. Muwanikwa, academic sponsors Ms. E. Marime, Mr. Shar and Mr. Tigere, my sisters and relatives. Special thanks goes to all the lecturers in the department of Local Governance Studies who greatly contributed in my studies up to date, this research could not be fruitful without the tireless efforts and the knowledge they impacted on me during my studies. Special mention goes to my committed supervisor Mrs. Bhosha who worked tirelessly to ensure that this research was properly nailed. She distinguished unconditional determination and assistance in helping me to realize the importance of this research as part of my studies and as an exclusive component in building my career. I am also deeply indebted to all the employees at Rushinga Rural District Council who shaped my career by providing their maximum support during my work related learning period. In uniqueness I salute the utmost support that l was given by the Chief Executive Officer Mr. Munyede. To mention as well are my fellow colleagues and friends who proved to be there for me when I needed their encouragement and advise most. These are namely Memory Mudonhi, Lydia Manjobo, Innocent Muyambwa, Captain and Fortunate Dhliwayo. For all this l am forever grateful. vii ABBREVIATIONS CEO : Chief Executive Officer COD : Cash on Delivery DA : District Administrator MDG : Millennium Development Goals MoHCC : Ministry of Health and Child Care PBC : Performance Based Contract PBF : Performance Based Financing RBF : Results Based Financing RBM : Results Based Management RRDC : Rushinga Rural District Council ZIMASSET : Zimbabwe Agenda for Sustainable Socio-Economic Transformation viii Table of contents APPROVAL FORM .................................................................................................................. ii RELEASE FORM ..................................................................................................................... iii DECLARATION ...................................................................................................................... iv DEDICATION ............................................................................................................................v ABSTRACT ............................................................................................................................. vi ACKNOWLEDGEMENT ........................................................................................................ vii ABBREVIATIONS ................................................................................................................ viii TABLE OF CONTENTS .......................................................................................................... ix LIST OF TABLES AND FIGURES ........................................................................................ xiii CHAPTER I ..............................................................................................................................1 INTRODUCTION .....................................................................................................................1 1.0 INTRODUCTION .............................................................................................................1 1.1 BACKGROUND INFORMATION ...................................................................................1 1.2 PROBLEM STATEMENT ................................................................................................5 1.3 RESEARCH OBJECTIVES ..............................................................................................5 1.4 RESEARCH QUESTIONS ................................................................................................6 1.5 SIGNIFICANCE OF THE RESEARCH /STUDY .............................................................6 1.6