Since 2003, Results Based Financing (RBF) has been implemented in Uganda in a pilot approach. Results from these pilots show that RBF can improve quality, quality, and delivery of services. However, there is scanty evidence on the how RBF specifically influences service providers to improve service delivery, and how it can be institutionalized. Therefore, this study aims to explore mechanisms and pathways through which RBF affects RMNCAH service delivery, and draw experiences and lessons for implementation and institutionalization of RBF as a performance improvement framework for health service delivery in Uganda.
The study will specifically: (i) identify and describe the most recent (2015-2018) donor-financed and national RBF Programs mainly within the RMNCAH domain in Uganda in respect to design, implementation framework, target population and service packages; (ii) examine the extent to which RBF design and implementation arrangements are consistent with the national RBF framework for Uganda; (iii) assesses the perceived extent and mechanisms of RBF influence on delivery and utilization of RMNCAH services; (iv) explore the factors facilitating and constraining implementation of RBF in Uganda; and (v) draw lessons from RBF implementation and implications thereof for national scale up and institutionalization and alignment of RBF with existing performance management and public finance reform programmes in Uganda.
This is a multiple case-study which utilises mixed methods of data collection namely abstraction, literature and document review, key informant interviews and focus group discussions with RBF funders, managers, programmers and implementers at national, district, and health facility level across the districts of Nebbi, Lira, Mukono, Kasese, Butaleja, and Kamuli. In phase 1, the study shall identify and characterise donor-financed and national RBF Programs in RMNCAH and other service areas that have been recently implemented in Uganda since 2015 and the extent of alignment with the national RBF framework. In phase 2, it will identify three case studies of RBF programs – the BTC/ENABEL RBF program, the Reproductive Health Voucher Phase 2 Project, and the URMCHIP RBF in order to generate in-depth understanding of the influences of RBF on quantity and quality indicators, the enablers and barriers to RBF implementation, and how RBF can be institutionalized and aligned to existing performance improvement platforms. Data will be audio-recorded, transcribed verbatim, shared across the study team for review and analysed for content inductively basing on theoretical themes and deductively basing on themes that answer the study objectives.