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Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

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...

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Autores principales: Paul, Elisabeth, Lamine Dramé, Mohamed, Kashala, Jean-Pierre, Ekambi Ndema, Armand, Kounnou, Marcel, Codjovi Aïssan, Julien, Gyselinck, Karel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kerman University of Medical Sciences 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745866/
https://www.ncbi.nlm.nih.gov/pubmed/29325401
http://dx.doi.org/10.15171/ijhpm.2017.42
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author Paul, Elisabeth
Lamine Dramé, Mohamed
Kashala, Jean-Pierre
Ekambi Ndema, Armand
Kounnou, Marcel
Codjovi Aïssan, Julien
Gyselinck, Karel
author_facet Paul, Elisabeth
Lamine Dramé, Mohamed
Kashala, Jean-Pierre
Ekambi Ndema, Armand
Kounnou, Marcel
Codjovi Aïssan, Julien
Gyselinck, Karel
author_sort Paul, Elisabeth
collection PubMed
description 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.
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spelling pubmed-57458662018-01-05 Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach Paul, Elisabeth Lamine Dramé, Mohamed Kashala, Jean-Pierre Ekambi Ndema, Armand Kounnou, Marcel Codjovi Aïssan, Julien Gyselinck, Karel Int J Health Policy Manag Original Article 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. Kerman University of Medical Sciences 2017-04-15 /pmc/articles/PMC5745866/ /pubmed/29325401 http://dx.doi.org/10.15171/ijhpm.2017.42 Text en © 2018 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Paul, Elisabeth
Lamine Dramé, Mohamed
Kashala, Jean-Pierre
Ekambi Ndema, Armand
Kounnou, Marcel
Codjovi Aïssan, Julien
Gyselinck, Karel
Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title_full Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title_fullStr Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title_full_unstemmed Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title_short Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
title_sort performance-based financing to strengthen the health system in benin: challenging the mainstream approach
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745866/
https://www.ncbi.nlm.nih.gov/pubmed/29325401
http://dx.doi.org/10.15171/ijhpm.2017.42
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