CHAI Health financing ZIM 2018-2021

Objective 1: Generate Evidence on Needs, Mobilise and Pool Resources CHAI provided technical assistance to the MoHCC in the costing, operational planning, gap analysis and Investment Case Development for several national strategic plans that guide health service delivery to significant populations, such as The Extended HIV Care and Treatment Strategic Plan 2018-2020, The Zimbabwe Health Sector HIV and STI Strategic Plan 2021-2025, Zimbabwe National Health Strategy 2021-2025 and the Strategic Plan to Eliminate Viral Hepatitis in Zimbabwe 2022-2024. CHAI explored innovative financing for the non-communicable diseases (NCDs) affecting a large population in Zimbabwe. CHAI developed a policy brief and financial analysis on taxing cigarettes and energy drinks. The MoFED adopted the recommendations in the 2022 National Budget and introduced the NCD Fund. The taxes on cigarettes and energy drinks are projected to generate $20 million and $5 million per annum, benefiting 2.2 million people and averting 42,000 deaths per annum. Objective 2: Improve Financial Resource Management RMET data has expanded to assist in policy and technical decision-making processes, including financial gap analyses for strategic plans, prioritising resources for the MoHCC budget bid, and supporting donor operational planning exercises (PEPFAR, HDF). CHAI also supported the development of the Health Sector Coordination Framework (HSCF) that will improve virtual pooling through coordination and harmonised funding. CHAI, WHO, and the World Bank developed the HSCF and TORs for Health Financing Technical Working Group, formally appointed in 2019. The TWG acts as a "clearing house" by identifying health financing issues, prioritising them, and proposing solutions to the MOHCC leadership. Other TWGs on other key health systems pillars have also been set up for supply chain management and HRH. However, changes due to covid-19 and the MoHCC structure have resulted in inconsistent frequency and level of engagement with TWGs. Objective 3: Identify Efficiencies in Health Workforce CHAI actively contributed to developing the National Community Health Strategy (NCHS), which aligns and strengthens governance and financing structures through harmonised community interventions. The NCHS aims to equitably distribute, appropriately train, and sustainably finance the Village Health Worker (VHW) cadre. CHAI developed the Community Essential Health Package (CEHP) using the life cycle approach that prioritises interventions based on an individual's growth from infancy to adulthood. CHAI trained VHWs in Mashonaland East on the package and strategy. We also developed reporting tools to plug community health information gaps in the national HMIS. The trained VHWs will be leveraged to the revised reporting tools in Mashonaland East province before national scale-up. Objective 4: Build Capacity at the Ministry of Health and Child Care CHAI built the capacity of the MOHCC Resource Mapping Team to enable them to take greater ownership of the process, assume increased responsibility for the performance of discrete activities and successfully institutionalised Resource Mapping as an annual MoHCC deliverable within the National Health Strategy. The exercise has mapped $8 billion in funding from public health funding sources, collected 100,000 rows of data and produced six annual resource mapping reports. The MOHCC team has since independently conducted analyses that have been used to inform national policy and strategic priorities. Furthermore, in 2021, the Resource Mapping Team supported a multi-sectoral analysis on covid-19 funding in response to a request by the Office of President and Cabinet. A total of $362 million in covid-19 data was collected from 16 Government Ministries and forty development partners. The data informed critical recommendations for the national covid-19 response. CHAI also successfully integrated the resource mapping process with the NHA and NASA, streamlining data collection and ensuring consistent financial health data across multiple exercises that inform health funding and allocation decisions across priority interventions. Objective 5: Regional Knowledge Sharing With the CHAI Zimbabwe and Malawi teams leading in conducting and harmonising resource tracking exercises, the two teams were funded by the GFF to conduct a case study on integrating the RM and NHA processes. The outputs included a report that would be shared across multiple CHAI countries looking to harmonise RM and NHA, including a detailed resource guide with technical training on harmonisation aspects and structural implications for streamlining processes. CHAI continued sharing its experiences through regional webinars that included Ministry of Health Policy and Finance Directors from the DRC, Benin, Burkina Faso, Burundi, Ethiopia, Malawi, Zambia, and Zimbabwe. Other officials included senior economists and regional health financing team leaders from the WHO, World Bank and GFF in East and West Africa (https://www.youtube.com/watch?v=ERUwTWQsHAk). CHAI also participated in regional and international meetings, shared health financing experiences, and attended WHO and World Bank courses in health financing to enhance our capacity-building role to the MOHCC.

The goal of this engagement is to empower the Ministry of Health and Child Care to improve equity, efficiency and accountability in the allocation and management of financial and human resources for health, towards the goal of increasing access to and utilization of essential basic health services including maternal and neonatal health (MNH). This will accelerate progress towards Zimbabwe’s goal of UHC. CHAI will support the government to implement the National Health Strategy and Health Financing strategy; generating evidence for and conducting key analyses and using these analyses to inform key resource allocation, policy and implementation decisions and management. CHAI will leverage our understanding of the context and relationships within the Ministry and with partners. CHAI’s health financing, MNH and other service delivery teams will work together to ensure that services can be sustainably financed and that increased resource allocation translates to improved access and quality of care. Through CHAI’s regional team we will learn from other countries and share lessons learned back with these countries. The key objectives to move towards this goal are to define financial and human resource needs, mobilize resources to meet these needs and identify and begin to address inefficiencies. Objective 1: Generate Evidence on Needs, Mobilize and Pool Resources. Assess and cost health needs, identify resource gaps, and develop investment cases to mobilize and pool funds for delivery of basic health services such as primary health care or MNH based on government priorities. Objective 2: Improve Financial Resource Management. Improve the way available financial resources for health are budgeted, allocated, and spent on health priorities; increasing value for money. Objective 3: Improve Health Workforce Planning and Management. Specifically, identify and operationalize opportunities to increase the efficient and effective use of resources related to health worker training, deployment, management and remuneration. This includes strengthening management and resource utilization related to public sector clinical workers as well as community health workforce. In pursuing these objectives, CHAI will also resolve to: Objective 4: Build national capacity at the MOHCC for evidence-based decision making and management. Objective 5: Support regional knowledge sharing by documenting methods and lessons learned and working closely or sharing knowledge with local and international stakeholders with support from the regional CHAI health financing and health workforce teams. This includes leveraging lessons learned from other countries. Under health financing objectives, this work will be supported by the regional health financing team funded by SIDA’s regional team for SRHR. The linkages between these objectives in moving towards the overall goal are described in the logical theory that can be found in the project proposal.