Zambia was awarded a grant in 2008 by the World Bank through the Health Results Innovation Trust Fund (HRITF) to implement a RBF pilot project with an accompanying Impact Evaluation (IE) led by the World Bank. Motivated by inadequate progress to achieving MDGs 4 and 5 targets, the primary objective of the project was to catalyze the country’s efforts to reduce under-five and maternal mortality in 11 districts in nine (9) of Zambia’s 10 provinces (except Lusaka) countrywide.
The Zambia health RBF (HRBF) pilot project was implemented by the Government through the Zambian health system (contracted-in) and is one of the few examples of a Lower Middle Income Country (LMIC) with this type of model. After a pre-pilot phase, which lasted approximately 2 years in the Eastern Province district of Katete, the RBF model was expanded to ten (10) additional districts in April 2012. By the end of the project, 203 health centres were covered across the country. This represented a total catchment population of about 1.5 million people of which the direct beneficiaries were 338,248 children aged between 0-59 months, and 372,073 women of childbearing age.
The accompanying IE comprised both quantitative and qualitative approaches. Quantitative data for the IE at household and facility level was collected at baseline, implementation stage, and endline from 10 RBF intervention districts; 10 Control 1 (C1) districts; and 10 Control 2 (C2) districts. The method of selecting districts for the IE was based on district-matched randomization. Inputs were assigned to the three district groups as follows: (a) The RBF Intervention group to receive Emergency Obstetric and Neonatal Care (EmONC) equipment and RBF performance-based grants; (b) The C1 group (“enhanced financing” arm) to receive EmONC equipment exactly as in the RBF and the equivalent in money of the average RBF performance-related grants as input financing; and (c) The C2 (“pure control” arm) group to receive nothing.
The IE investigated the impact of the RBF over a broad range of targeted and non-targeted indicators related to maternal and child health services. Baseline household data was collected over the period November to December 2011. Endline data was collected between November 2014 and January 2015, using the same survey tools and in the same study areas and was undertaken in 18 IE districts (all of the study districts in six of the matched district triplets yielding information from 6 RBF districts, 6 C1 districts, and 6 C2 districts). For the health facility survey, baseline data was collected between November and December 2011, and endline data was collected between November 2014 and January 2015.