Article (Scientific journals)
Local Stakeholders’ Perceptions About the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts
Paul, Elisabeth; Sossouhounto, Nadine; Eclou, Dieudonné
2014In International Journal of Health Policy and Management, 3
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Keywords :
Performance-based financing; Benin; Qualitative study; Stakeholders; Case study; Health district
Abstract :
[en] 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.
Disciplines :
Public health, health care sciences & services
Sociology & social sciences
Special economic topics (health, labor, transportation...)
Author, co-author :
Paul, Elisabeth  ;  Université de Liège - ULiège > Département des sciences de la santé publique > Département des sciences de la santé publique
Sossouhounto, Nadine;  Université d'Abomey-Calavi > LADYD
Eclou, Dieudonné;  Université d'Abomey-Calavi > LADYD
Language :
English
Title :
Local Stakeholders’ Perceptions About the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts
Publication date :
September 2014
Journal title :
International Journal of Health Policy and Management
eISSN :
2322-5939
Publisher :
Kerman University of Medical Science, Iran
Volume :
3
Peer reviewed :
Peer Reviewed verified by ORBi
Name of the research project :
GRAP-PA Santé
Funders :
CUD - Commission Universitaire pour le Développement [BE]
Available on ORBi :
since 30 October 2014

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