In 2008, with an increasingly unstable economy and uncontrollable hyperinflation, Zimbabwean public sector workers were faced with the choice of feeding and clothing their families or paying as much as a week's wages to get to work. 
The health sector was one of the hardest hit by this crisis as health sector workers abandoned the hospitals and chose other ways to earn the US dollars, South African rand or Botswana pula needed to buy food.
When the country was faced with a devastating cholera epidemic towards the end of the year, there were therefore few health workers turning up for work. Although aid was available in the form of medical supplies and pharmaceuticals, this had very little impact in saving lives with so few health workers in the health delivery system. In response to this challenge donors had devised the Human Resources Retention Scheme which involved incentivisation payments to all health workers paid in US dollars. With emergency funds from DFID, Crown Agents designed a model to deliver the retention allowance payments to the areas affected by the epidemic and to ensure that appropriate controls were in place so that the health workers were paid the correct allowance and duplicate payments were prevented. The first phase of payments established credibility and confidence through more people reporting for duty: a UNICEF survey reported an immediate increase in staff attendance of 20-30%.
Logistically, making the payments was not easy as the majority of Zimbabweans did not have foreign currency accounts, so in the pilot phase less than 10% of beneficiaries were able to receive their payments into an account. Crown Agents Zimbabwe therefore had to devise a mechanism to pay the remainder in cash through local banks and even bank tellers in the hospitals. Since then, the majority of beneficiaries have graduated to payment through account transfers as confidence and trust in the banking sector has returned, with the additional benefit of a strengthened domestic banking system.
The success of the initial phase resulted in more donors becoming involved and the scheme continues, using pooled funds from multiple donors. It is estimated that more than 30,000 health sector workers have been paid a total of US$ 25 million through this project to date, and health delivery systems have been maintained to support the people of Zimbabwe.