Effects of Direct Healthcare Financing on Strategic Health Indicators in Rural Health Facilities of Chikankata District of Zambia: 2014 – 2018

Keywords: Direct health care financing;, strategic health indicators;, rural health facilities;


Healthcare financing is the process of utilizing financial inputs necessary for health interventions. Health facilities do not routinely access the monthly government grant due to challenges in the access and utilization process. It is unclear if the lack of grant receipt affects strategic health indicators and thus access quality healthcare provision in rural Zambia. This study aimed at investigating the effect of funding access on health facility performance. The study analyzed data for 15 health facilities in Chikankata district from 2014 to 2018. Data was collected from the health management information system and analyzed against accounting records to determine if facilities performed better in antenatal care, Immunization and Institutional deliveries when they received their monthly grants. Grant receipt had a statistically significant (p=0.04) association with performance in maternal and child health indicators, measured by a mean composite score OR 1.46, 95% CI [1.03, 2.08]. The association between grant receipt and indicator performance was most significant on institutional deliveries OR 1.75, 95% [1.13, 2.73]. Grant receipt by the facilities was associated with an improvement in maternal and child health indicators. This demonstrates the need for effective healthcare financing mechanisms that consider the monthly grant in improving performance by facilities. Performance Based Financing mechanisms should however be combined with direct financing mechanisms to holistically improve primary healthcare. The implications of these findings are that as much as practical, funding disbursement modalities must ensure that all health facilities receive some funding.