Nurses' views and experiences regarding implementation of results based financing in Zimbabwe

Abstract

Results Based Financing (RBF) models are results oriented, linking performance indicators to incentives to motivate health workers to deliver quality care in anticipation of rewards attached to service delivery. The study sought to explore nurses’ views and experiences regarding the implementation of RBF in Zimbabwe with the aim of recommending measures to strengthen the programme. The researcher used a qualitative, exploratory and descriptive design in this study. The population of this study comprised 21 nurses. Non-probability purposive sampling was used to select professional nurses involved in implementing RBF in Mrewa District, Mashonaland East Province, Zimbabwe. Data were collected through focus group discussions using an interview guide. Three (3) focus group discussions were conducted during this study, following a pilot study consisting of six (6) conveniently sampled nurses in Mashonaland East Province. Interviews were tape recorded and transcribed verbatim. Permission to proceed with this study was granted by the Ministry of Health and Child Care and the University of South Africa. Measures to ensure credibility, dependability, conformability and transferability were followed. Data were analysed using Creswell’s data analysis steps. Data were transcribed and thematically analysed, and emerging patterns were noted. The researcher examined these categories closely and compared them for similarities and differences, identifying the most frequent or significant codes in order to develop the main categories. These were summarised in narrative form. Four themes emerged from data: interpretation of RBF; role of nurses in the implementation of RBF; evaluation of RBF; and strengthening implementation of RBF. The study revealed various interpretations of RBF that converged to definitions of RBF in literature. Nurses viewed themselves as key and important players in the successful implementation of RBF. The successes and challenges of RBF were presented. Several measures that could strengthen the implementation of donor funds were highlighted, including subsidisation of low catchment health facilities, inclusion of district hospitals on the RBF programme, increasing financial autonomy of health facilities and the review of procurement guidelines. The study assumed that these measures will enhance nurses’ work experience in donor funded health care delivery, and improve health outcomes.