| Summary: | The results-based financing (RBF) program, first implemented in Zimbabwe in 2011 and
gradually expanded to other districts, aimed to address disparities in maternal health outcomes
by improving the utilisation of health services. This study leverages the staggered rollout of
the program as a quasi-experimental design to assess its impact on asset wealth-related
inequalities in selected maternal health outcomes. The objective is to determine whether RBF
can effectively reduce these disparities and promote equitable healthcare access. We employ
an extended two-way fixed effects (ETWFE) model to exploit temporal variation in RBF
implementation as well as individual-level variation in birth timing for identification. Utilising
pooled cross-sectional and nationally representative data from the Zimbabwe demographic and
health surveys collected between 1999 and 2015, our analysis reveals significant reductions in
relative and absolute maternal health inequalities, especially in the frequency and timing of
prenatal care, delivery by caesarean section, and family planning. Specifically, the RBF
program is associated with reductions in disparities for completing at least four or more
prenatal care visits (-0.026, p < 0.01), first-trimester prenatal care (-0.033, p < 0.01), delivery
by caesarean section (-0.028, p < 0.005), and family planning (-0.033, p < 0.005). Additionally,
the program is associated with improved prenatal care quality, as evidenced by progress on the
prenatal care quality index (-0.040, p < 0.01). These effects are more pronounced among lower
socioeconomic groups in RBF districts, highlighting RBF's potential to promote equitable
healthcare access. Our findings advocate for targeted policy interventions prioritising
expanding access to critical maternal health services in underserved areas and incorporating
equity-focused measures within RBF frameworks to ensure inclusive and effective healthcare
delivery in Zimbabwe.
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