Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 11:76:4.
doi: 10.1186/s13690-017-0250-4. eCollection 2018.

A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months

Oriane Bodson  1 , Ahmed Barro  2 , Anne-Marie Turcotte-Tremblay  3 , Nestor Zanté  2 , Paul-André Somé  2 , Valéry Ridde  3   4
Affiliations

A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months

Oriane Bodson et al. Arch Public Health. .

Abstract

Background: Performance-based financing (PBF) in the health sector has recently gained momentum in low- and middle-income countries (LMICs) as one of the ways forward for achieving Universal Health Coverage. The major principle underlying PBF is that health centers are remunerated based on the quantity and quality of services they provide. PBF has been operating in Burkina Faso since 2011, and as a pilot project since 2014 in 15 health districts randomly assigned into four different models, before an eventual scale-up. Despite the need for expeditious documentation of the impact of PBF, caution is advised to avoid adopting hasty conclusions. Above all, it is crucial to understand why and how an impact is produced or not. Our implementation fidelity study approached this inquiry by comparing, after 12 months of operation, the activities implemented against what was planned initially and will make it possible later to establish links with the policy's impacts.

Methods: Our study compared, in 21 health centers from three health districts, the implementation of activities that were core to the process in terms of content, coverage, and temporality. Data were collected through document analysis, as well as from individual interviews and focus groups with key informants.

Results: In the first year of implementation, solid foundations were put in place for the intervention. Even so, implementation deficiencies and delays were observed with respect to certain performance auditing procedures, as well as in payments of PBF subsidies, which compromised the incentive-based rationale to some extent.

Conclusion: Over next months, efforts should be made to adjust the intervention more closely to context and to the original planning.

Keywords: Burkina Faso; Developing countries; Fidelity; Health financing; Implementation; Performance-based financing.

PubMed Disclaimer

Conflict of interest statement

The study was approved by Burkina Faso’s national health research ethics committee and the research ethics committee of the University of Montreal Hospital Research Center. All persons and authorities involved in this study were informed of its objectives and gave their informed consent.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Comparison of the degrees of implementation of performance audits among health districts (HD)
Fig. 2
Fig. 2
Comparison of implementation fidelity of activities related to determination and payment of subsidies by HD
Fig. 3
Fig. 3
Comparison of implementation by HD
Fig. 4
Fig. 4
Comparison of implementation by tier and level of care
Fig. 5
Fig. 5
Comparison of implementations by dimension and by HD
See this image and copyright information in PMC

References

    1. Gautier L, Ridde V. Health financing policies in sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes Global Health Research and Policy. 2017;2:23. doi: 10.1186/s41256-017-0043-x. - DOI - PMC - PubMed
    1. Renmans D, Holvoet N, Orach CG, Criel B. Opening the « black box » of performance-based financing in low-and lower middle-income countries : a review of the literature. Health Policy Plan. 2016;31(9):1297–1309. doi: 10.1093/heapol/czw045. - DOI - PubMed
    1. Bonfrer I, Van de Poel E, Van Doorslaer E. The effects of performance incentives on the utilization and quality of maternal and child care in Burundi. 2014;123:96–104. - PubMed
    1. Skiles MP, Curtis SL, Basinga P, Angeles G, Thirumurthy H. The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda. BMC Health Serv Res. 2015;15:375. doi: 10.1186/s12913-015-1033-7. - DOI - PMC - PubMed
    1. Rudasingwa M, Soeters R, Basenya O. The effect of performance-based financing on maternal healthcare use in Burundi: a two-wave pooled cross-sectional analysis. Glob Health Action. 2017;10(1) - PMC - PubMed

LinkOut - more resources