References of "Paul, Elisabeth"
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See detailPrivate healthcare providers and PHC: gateway to marketization or untapped potential to strengthen PHC?
Paul, Elisabeth ULiege

Scientific conference (2018, October 23)

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See detailPerformance-based financing (PBF) in low- and middle-income countries: What is the theory of change, actually?
Paul, Elisabeth ULiege; Bodson, Oriane ULiege; Ridde, Valéry

Poster (2018, October 12)

Performance-based financing (PBF) is expanding in low- and middle-income countries (LMICs) despite mixed results; indeed, it has been criticised for potential perverse effects and unintended effects are ... [more ▼]

Performance-based financing (PBF) is expanding in low- and middle-income countries (LMICs) despite mixed results; indeed, it has been criticised for potential perverse effects and unintended effects are demonstrated. Attributing results to PBF as such is extremely difficult because (i) health systems inherently comprise “structural” incentives and are subject to various reforms beyond PBF; and (ii) there are misunderstandings and controversies about the mere definition and the theory behind PBF. Moreover, PBF schemes encompass different components (e.g. financial premiums conditioned on reaching pre-agreed results, focus and feedback on key performance indicators, coaching, additional resources at facility level, …) and their designs may infinitely vary. Yet, we still did not have a clear and consistent explanation of why and how PBF is supposed to produce results. We explore (i) the theoretical justification of PBF and (ii) the theory of change (ToC) of PBF in the health sector in LMICs. The literature on PBF-related approaches is fragmented across disciplines. -The most commonly used theory to justify PBF is the principal-agent theory. Theory-based evaluation has progressively imposed itself as more appropriate approach to study complex issues. There are few theory-based evaluations and partial attempts to “open the black box” of PBF and identify its ToC / programme theory / causal pathways / mechanisms / transmission of effects. PBF has to a large extent been justified theoretically on the grounds of economic currents – even if the economic rationale is limited by the validity of its (sometimes very) limitative assumptions. For instance, the principal-agent theory does not hold in complex systems such as health. As a conclusion: - The theories used to justify PBF to date are few and insufficiently credible - Studies aimed at uncovering the ToC of PBF are recent and unfinished - Most existing PBF ToCs are not theory-based - Actors need to make the theories underlying their interventions more explicit, disentangling the PBF package - Performance premiums conditioned on reaching a number of predetermined performance criteria may not be justified - If PBF is justified neither by strong theoretical arguments, nor by generalizable evidence, it is definitely marked by a neoliberal ideology, and the promotion of lack of trust and competition over cooperation between actors in the health system - Taboo: Is the debate over PBF definition a way to conceal the debate over PBF ideology [less ▲]

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See detailOser remettre en question un modèle voyageur ? Le cas du financement basé sur les résultats (FBR) en Afrique
Paul, Elisabeth ULiege; Ridde, Valéry

Conference (2018, July)

Le financement basé sur les résultats (FBR) dans le secteur de la santé est typiquement un modèle voyageur. À la suite de quelques expériences pilotes et à une expérience présentée comme une « success ... [more ▼]

Le financement basé sur les résultats (FBR) dans le secteur de la santé est typiquement un modèle voyageur. À la suite de quelques expériences pilotes et à une expérience présentée comme une « success story » dans le contexte atypique du Rwanda, le FBR est maintenant promu par la Banque mondiale avec le financement du Health Results Innovation Trust Fund (HRITF) dans une vingtaine de pays africains aux contextes pourtant très variés. Il fait l’objet d’une « communauté de pratiques » très active. Cependant, la diffusion du FBR ne repose pas sur un corpus suffisant de preuves de son efficacité, efficience, équité et encore moins de sa pérennité. Nous avons récemment publié, avec une vingtaine de collègues, un article polémique qui argue que la mise en œuvre du FBR a été précipitée, que le modèle n’est pas approprié par la plupart des pays où il est implanté, et qu’il peut affaiblir les systèmes de santé des pays concernés (Paul et al. 2018). Cette publication a suscité des réactions parfois virulentes, tant individuelles (notamment sur le blog de la revue BMJ Global Health) que collectives, avec un appel à réponse lancé au sein de cette communauté de pratiques. Cette communication s’intéresse aux acteurs impliqués dans la diffusion du FBR et plus particulièrement, aux réactions que notre article a suscitées. Après avoir présenté notre thèse, nous présentons les arguments qui nous ont été opposés par les collègues que nous avions contactés mais qui n’ont pas souhaité rejoindre la liste des signataires de l’article polémique – parmi lesquels la peur d’affronter les promoteurs du FBR, celle de perdre leur neutralité, ou encore de perdre des opportunités de financements. Ensuite, nous synthétisons les réactions engendrées par notre article. Si certaines sont constructives et proposent des adaptations aux contextes de l’approche FBR, d’autres sont très personnelles et démontrent un manque de prise de distance des acteurs vis-à-vis de l’objet FBR – sans compter que la grande majorité des acteurs ayant réagi sont en conflits d’intérêts, parfois annoncés. Les réactions convoient également des croyances bien enracinées dans les discours des acteurs de la santé mondiale. En particulier, si les débats tournent autour de l’adaptation « technique » (au niveau du design ou de l’implantation) du modèle de FBR pour produire de meilleurs résultats – le FBR étant en effet un modèle comprenant de multiples composantes – aucune remise en cause fondamentale n’est faite de l’approche théorique de lier le financement à des résultats mesurés. Nous concluons en explicitant l’idéologie sous-jacente au FBR, jusque-là rarement exprimée, et en appelant ses promoteurs à mieux préciser la « théorie du changement » du FBR. Référence : Paul, Elisabeth, Lucien Albert, Badibanga N’Sambuka Bisala, et al. (2018) Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink? BMJ Glob Health 2018;3:e000664. (doi:10.1136/ bmjgh-2017-000664) [less ▲]

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See detailPerformance-Based Financing in Africa: Time to Test Measures for Equity
Ridde, Valéry; Gautier, Lara; Turcotte-Tremblay, Anne-Marie et al

in International Journal of Health Services (2018)

Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness ... [more ▼]

Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030. [less ▲]

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See detailComment utiliser l’expérience de financement basé sur les résultats (FBR) pour rendre l’achat des services de santé plus stratégique au Bénin?
Paul, Elisabeth ULiege; Sieleunou, Isidore; Ridde, Valéry

in Cahiers Réalisme (2018), 15

Le Bénin a expérimenté la mise en œuvre du financement basé sur les résultats (FBR) dans le secteur de la santé selon deux approches. Suite à l'échec des tentatives d'harmonisation et de rationalisation ... [more ▼]

Le Bénin a expérimenté la mise en œuvre du financement basé sur les résultats (FBR) dans le secteur de la santé selon deux approches. Suite à l'échec des tentatives d'harmonisation et de rationalisation de ces approches en vue de la pérennisation du FBR, le gouvernement du Bénin n'a pas pris les dispositions pour poursuivre sa mise en œuvre. Dans la poursuite de la couverture santé universelle, le pays s'est engagé dans la voie de l'Assurance pour le renforcement du capital humain (ARCH) qui vise notamment à développer l'assurance maladie. Or, la promotion d'une couverture maladie nécessite entre autres de renforcer les mécanismes d'achat stratégique. Cet article synthétise les principaux éléments d'une note d'orientation élaborée par les experts en charge de l'appui scientifique au programme d'appui au secteur santé de l'Agence belge de développement. Il vise à proposer une évolution de l’approche de FBR mise en œuvre au Bénin vers une approche d'achat stratégique des services et soins de santé, ceci en vue de garantir l'efficience, la qualité et l'équité de l’accès aux soins de santé. Il a pour vocation plus large de partager l'expérience du Bénin avec les pays et les partenaires qui souhaiteraient passer d'un programme de FBR appuyé par les donateurs à un mécanisme d'achat stratégique plus englobant et intégré dans le système local de santé. L'article se base sur une revue non systématique de la littérature et l'expérience des auteurs au Bénin et ailleurs. Tout d'abord, le concept d'achat stratégique est clarifié, et quelques leçons de l'expérience sont mises en avant, pouvant être utiles pour les pays qui souhaitent rendre l'achat des services de santé plus stratégique. Ensuite, les leçons apprises de l'expérience du FBR au Bénin sont présentées, qui touchent à la fois aux niveaux des processus stratégiques (importance d'adopter une vision systémique et de renforcer la redevabilité au niveau local), des processus techniques (importance de recourir aux structures pérennes en les renforçant, de limiter les coûts de transaction, de fournir des appuis complémentaires au renforcement du système local de santé), ainsi que des processus de suivi et des indicateurs de résultat (rationalisation des matrices d'indicateurs et des processus de vérification, accent sur des indicateurs ayant un effet de levier sur le système, équité). Quelques écueils sont également relevés (dont l'appropriation, la capitalisation des expériences et l'intégration des programmes de FBR dans les institutions existantes). Enfin, plusieurs pistes sont proposées dans le cadre de la transition du FBR vers l'achat stratégique. Il est suggéré, à court terme, d'adopter un aménagement transitoire du modèle de FBR, visant à le rationaliser. Après une période transitoire, l'accent devrait être mis sur quatre éléments de décision de l'achat stratégique à travers, d'une part, un appui au mécanisme d’assurance maladie pour ce qui concerne l'achat des prestations, ainsi qu'à l’'utorité de régulation du secteur de la santé pour le "stewardship"; et d’autre part, la poursuite des appuis au système national d’information sanitaire ainsi qu'au renforcement des systèmes locaux de santé. [less ▲]

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See detailPerformance-based financing in low-income and middle-income countries: isn’t it time for a rethink?
Paul, Elisabeth ULiege; Albert, Lucien; Bisala, Badibanga N'Sambuka et al

in BMJ Global Health (2018), 3:e000664

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and ... [more ▼]

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to systemwide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches. [less ▲]

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See detailUniversal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options
Paul, Elisabeth ULiege; Fecher-Bourgeois, Fabienne ULiege; Meloni, Remo et al

in Global Health, Science and Practice (2018)

Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role ... [more ▼]

Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial “mapping” of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and “evidence-informed deliberative processes” where the trade-offs along the 3 dimensions of UHC—extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures—can be discussed in a transparent and contextualized setting. [less ▲]

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See detailPerformance-Based Financing in the heath sector in low- and middle-income countries: Is there anything whereof it may be said, See, this is new?
Paul, Elisabeth ULiege; Renmans, Dimitri

in International Journal of Health Planning and Management (2018), 33(1), 51-66

Whereas performance‐based financing (PBF) is now developing fast in the health sector in low‐ and middle‐income countries and is presented an innovative approach—concomitantly, subject to a separate ... [more ▼]

Whereas performance‐based financing (PBF) is now developing fast in the health sector in low‐ and middle‐income countries and is presented an innovative approach—concomitantly, subject to a separate research stream—it sharesmany features of the “managing for results” (MfR) and performance‐based budgeting (PBB) currents that have existed for decades. In this paper, we first argue that PBF as currently developed in the health sector in low‐ and middle‐income countries shares many features and thus can be viewed as an avatar of MfR andmore precisely PBB. Secondly,we draw lessons from the literature on MfR and PBB so as to (1) better apprehend PBF conceptually and (2) avoid pitfalls and better design PBF schemes in practice. We argue that the lessons from the theoretical and empirical literature on MfR and PBB offer interesting insights to feed into a “theory of change” of PBF, enabling to analyse critical aspects and better design PBF schemes. Moreover, it is hoped that just like MfR processes have been demonstrated as having the potential to boost individual performance not only through links with financial incentives but also through acting on other sources of motivation, one can demonstrate more accurately by which mechanisms the various elements of the PBF package can help improve health sector results. [less ▲]

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See detailPerformance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
Paul, Elisabeth ULiege; Dramé, Mohamed L.; Kashala, Jean-Pierre et al

in International Journal of Health Policy and Management (2018), 7(1), 35-47

Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian ... [more ▼]

Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC) followed suit through a health system strengthening (HSS) project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods: An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results: Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms), as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and sustainability issues are also discussed. Conclusion: BTC’s alternative PBF approach is both promising in terms of effects, ownership and sustainability, and less resource consuming. This experience testifies that PBF is not a uniform or rigid model, and opens the policy ground for recipient governments to put their own emphasis and priorities and design ad hoc models adapted to their context specificities. However, integrating PBF within the normal functioning of local health systems, in line with other reforms, is a big challenge. [less ▲]

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See detailMatrices d’indicateurs et de mesures des deux modèles de FBR au Bénin
Paul, Elisabeth ULiege; Badarou, Soliou; Bodson, Oriane ULiege et al

in Chaire Réalisme - Note de politique (2017, March)

Cette note de politique fait l'analyse critique des matrices d’indicateurs quantitatifs et de mesures qualitatives des deux programmes de FBR au Bénin, et proposer des pistes pour améliorer la cohérence ... [more ▼]

Cette note de politique fait l'analyse critique des matrices d’indicateurs quantitatifs et de mesures qualitatives des deux programmes de FBR au Bénin, et proposer des pistes pour améliorer la cohérence et l’intégration du FBR dans la perspective de l’atteinte de la CSU [less ▲]

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See detailLe FBR doit être mieux intégré avec les différentes stratégies, réformes et activités du secteur de la santé au Bénin
Paul, Elisabeth ULiege; Dramé, Mohamed Lamine

in Chaire Réalisme - Note de politique (2017, March)

De nombreuses réformes sont conçues comme des programmes, tels que le financement basé sur les résultats (FBR) et les initiatives de rétention et de motivation des ressources humaines. Au Bénin, on ... [more ▼]

De nombreuses réformes sont conçues comme des programmes, tels que le financement basé sur les résultats (FBR) et les initiatives de rétention et de motivation des ressources humaines. Au Bénin, on constate la fragmentation de stratégies visant à améliorer la motivation et la rétention du personnel de santé en vue d’une meilleure performance. Il est nécessaire de mieux comprendre les « canaux de transmission » à travers lesquels les différents éléments du FBR interagissent et impactent sur les résultats, et de veiller à sa cohérence interne et externe. Il nous apparaît crucial d’envisager le FBR dans une perspective systémique, comme un mécanisme visant au renforcement du système de santé. Et ce faisant, de l’intégrer dans le fonctionnement normal des services de santé, en cohérence avec l’ensemble des autres réformes en cours et les systèmes existants. [less ▲]

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See detailHarmonisation et rationalisation du FBR en vue de sa pérennisation au Bénin
Paul, Elisabeth ULiege; Kashala, Jean-Pierre; Sokegbe, Séverin et al

in Chaire Réalisme - Note de politique (2017, March)

Le financement basé sur les résultats (FBR) a été développé au Bénin dès 2012 selon deux modèles. À la suite de son passage à échelle nationale, un processus d’harmonisation et de rationalisation du FBR ... [more ▼]

Le financement basé sur les résultats (FBR) a été développé au Bénin dès 2012 selon deux modèles. À la suite de son passage à échelle nationale, un processus d’harmonisation et de rationalisation du FBR en vue de sa pérennisation a été entamé en 2015. Toutefois, le processus a été contraint par le manque d’appropriation nationale, ce qui a empêché la définition d’un modèle de FBR unique et pérenne. Les conditions nécessaires pour garantir la pérennisation sont le renforcement de l’appropriation nationale, la transparence, la définition d’un modèle national intégré dans les institutions locales, efficace et efficient. [less ▲]

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See detailLa couverture santé universelle dans les pays à revenus faibles et intermédiaires : analyses économiques
Paul, Elisabeth ULiege; Bodson, Oriane ULiege; Ridde, Valéry et al

in Reflets et Perspectives de la Vie Economique (2016), 1

Les pays à revenu faible et intermédiaire sont confrontés à des besoins de financement élevés pour assurer une couverture santé universelle (CSU) permettant à chacun d'avoir accès à des services de santé ... [more ▼]

Les pays à revenu faible et intermédiaire sont confrontés à des besoins de financement élevés pour assurer une couverture santé universelle (CSU) permettant à chacun d'avoir accès à des services de santé de qualité sans encourir de difficultés financières. Cet article tente de montrer comment l'analyse économique peut être mobilisée pour identifier des stratégies utiles pour tendre vers la CSU. Trois axes complémentaires où l'analyse économique a une plus-value sont présentés : i) la mobilisation des ressources et l'équité verticale ; ii) l'amélioration de l'efficacité dans l'allocation des ressources et l'équité horizontale ; iii) la gestion opérationnelle des ressources, en particulier à travers le financement basé sur les résultats (efficience). Pour chacun, nous présentons un bref état des lieux de l'état des connaissances et évoquons quelques perspectives de recherche. [less ▲]

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See detailPerformance-Based Aid: Why it will probably not meet promises
Paul, Elisabeth ULiege

in Development Policy Review (2015), 33(3),

Performance-based aid (PBA) is increasingly advocated as a way to improve development aid effectiveness through resolving incentive issues inherent in aid relationships. Some donors use PBA together with ... [more ▼]

Performance-based aid (PBA) is increasingly advocated as a way to improve development aid effectiveness through resolving incentive issues inherent in aid relationships. Some donors use PBA together with performance-based financing arrangements within partner countries. Expectations from PBA are high – yet, while its rationale may look appealing, it is grounded on a restrictive model and flawed when taking account of real-world context. A number of problems associated to PBA have already been advanced as jeopardising its success. More fundamentally, one may question the mere appropriateness of PBA to provide incentives all along the chain from recipient governments to those who are supposed to produce results. Thus believing that PBA can have a mechanistic trickle-down incentive effect seems an illusion. [less ▲]

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See detailStakeholder incentives and aid effectiveness: A case study in the health district of Kayes in Mali
Devahive, Eva; Paul, Elisabeth ULiege; Samaké, Salif et al

in Journal of Development Studies (2015)

This case study analyses how far donors implement aid effectiveness principles at health district level in Mali, and why. It shows that not all aid effectiveness principles are implemented at a similar ... [more ▼]

This case study analyses how far donors implement aid effectiveness principles at health district level in Mali, and why. It shows that not all aid effectiveness principles are implemented at a similar degree. Most projects have limited impact on health services, but many programmes supported by donors offer positive opportunities for health system strengthening. The representations of different categories of stakeholders diverge – notably, regarding the role of different actors in service provision. A number of consistent strategic logics influence actors’ behaviour. We show that while many donors have committed at global level to respect aid effectiveness principles, implementation lags behind. [less ▲]

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See detailLocal Stakeholders’ Perceptions About the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts
Paul, Elisabeth ULiege; Sossouhounto, Nadine; Eclou, Dieudonné

in International Journal of Health Policy and Management (2014), 3

Background: Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study ... [more ▼]

Background: Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. Methods: The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis. Results: The Ministry of Health (MoH) strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak — and ‘blurred’ — to have a lasting inciting effect. It rather seems that PBF motivates health workers through other elements of its ‘package’, especially formative supervisions. Conclusion: If the global picture is quite positive, several issues could jeopardise the success of PBF. It appears crucial to reduce the perceived unfairness in the system, notably through enhancing all facilities’ capacities to ensure they are in line with national norms, as well as to ensure financial and institutional sustainability of the system. [less ▲]

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See detailComment on : “Do Sector-Wide Approaches for health aid delivery lead to ‘donorflight’? A comparison of 46 low-income countries” by Rohan Sweeney, Duncan Mortimer, and David W. Johnston
Paul, Elisabeth ULiege; Porignon, Denis ULiege; Dujardin Bruno, et al

in Social Science and Medicine (2014)

Critique of a published paper on health SWAps. We question the core of the article, as it is to us based on wrong assumptions, a maladapted design, questionable data, and it leads to dangerous conclusions.

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See detailL'efficacité de l'aide en santé en Afrique de l'Ouest: maintenant plus que jamais
Paul, Elisabeth ULiege; Eclou, Dieudonné; Sossouhounto, Nadine et al

in Global Health Promotion (2013)

La préoccupation d'améliorer l'efficacité de l'aide au développement dans le secteur de la santé est plus que jamais d’actualité. L'approche sectorielle permet d'obtenir des améliorations importantes à ce ... [more ▼]

La préoccupation d'améliorer l'efficacité de l'aide au développement dans le secteur de la santé est plus que jamais d’actualité. L'approche sectorielle permet d'obtenir des améliorations importantes à ce niveau et connaît un renouveau à travers le Partenariat International pour la Santé et initiatives liées (IHP+). Dans ce commentaire, nous montrons comment l'IHP+ a été mis en œuvre dans trois pays ouest-africains francophones: le Bénin, le Burkina Faso et le Mali. La dynamique existant dans le secteur de la santé dans chacun des pays a influencé la façon dont l'IHP+ s’y est traduit. Au-delà de ces dynamiques différentes, l'IHP+ a permis de renforcer la place des plans et dispositifs nationaux de coordination comme plateforme de suivi-évaluation et de redevabilité du secteur santé. Toutefois, certaines pratiques contraires aux principes de l'efficacité de l'aide perdurent encore, en particulier le manque d'alignement sur les systèmes de gestion nationaux et le manque de prévisibilité de l'aide. [less ▲]

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