| Summary: | This study evaluates the impact of results-based financing (RBF) on maternal health
outcomes and the inequality of opportunity (IOP) in these outcomes in Zimbabwe. We
employ a difference-in-differences approach that leverages the staggered
implementation of the programme across 60 districts, exploiting temporal variation in
the introduction of RBF alongside individual-level variation in birth timing and health
facility selection. Our analysis uses nationally representative, pooled cross-sectional
data from the 2005/2006, 2010/2011, and 2015 Zimbabwe demographic and health
surveys. Employing the extended two-way fixed effects (ETWFE) estimator to address
biases associated with staggered rollouts, we find significant positive effects of RBF on
maternal health outcomes. The programme is associated with an increase in the
number of prenatal care visits by 0.185 units (p < 0.01), first-trimester care by 7.7
percentage points (pp) (p < 0.01), facility births by 8.6 pp (p < 0.01), and professional
delivery assistance by 3.4 pp (p < 0.01), while reducing C-section rates by 1.3 pp (p <
0.01). Additionally, RBF reduces IOP in prenatal care visits, early prenatal care, facility
births, and professional delivery assistance by 3.8, 1.3, 8.4, and 4.9 pp (p < 0.01),
respectively. These findings underscore the potential of RBF to enhance maternal
health outcomes and promote health equity. Integrating equity considerations into
health system strengthening initiatives is essential. Policymakers must ensure health
interventions improve access and balance opportunities across various socioeconomic
and demographic groups. This evidence supports RBF schemes to improve access to
and equity in healthcare services, particularly in low-income settings such as Zimbabwe.
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