Sieleunou Isidore, Turcotte-Tremblay Anne-Marie, Fotso Jean-Claude Taptué, Tamga Denise Magne, Yumo Habakkuk Azinyui, Kouokam Estelle, Ridde Valery
University of Montreal, 7101, avenue du Parc, Montréal, Québec, H3N 1X9, Canada.
Research for Development International, 30883, Yaoundé, Cameroon.
Global Health. 2017 Aug 1;13(1):52. doi: 10.1186/s12992-017-0278-9.
More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon.
The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis.
By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change.
The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers' actions and choices.
撒哈拉以南非洲地区有30多个国家已在其医疗体系中引入了基于绩效的融资（PBF）。然而，关于PBF在非洲被列入国家政策议程的过程，相关研究甚少。本研究考察了喀麦隆引入PBF项目背后的政策过程。
本研究是一项解释性案例研究，采用金登多源流框架。我们进行了文献回顾，并对政策过程中涉及的各类行为体进行了25次访谈。我们采用混合演绎-归纳法进行主题分析以进行数据分析。
到2004年，几份报告和一些事件提供了该国健康状况不佳和卫生融资状况的证据，从而提高了对该情况的认识。结果，决策者将缺乏合适的卫生融资政策确定为一个需要解决的重要问题。政治话语向更强问责制的转变为测试新机制创造了空间。来自世界银行的一群政策企业家，通过多种形式的影响（财政、观念、网络和知识方面的影响），并基于正在进行的几项改革，与政府高级官员合作，将PBF项目列入议程。政策变化是两个开放政策窗口（即国内和国际窗口）导致的结果，在这两种情况下，政策企业家都能够将政策流结合起来以实现变革。
喀麦隆PBF的政策议程强调了政策改革过程中感知到的危机的重要性以及组建团队推进政策过程的优势。它还突出了科学证据之外的其他信息来源（如研讨会和考察访问）的作用，以及先前政策和经验在分别塑造或影响问题的框架设定方式以及改革者的行动和选择方面的作用。
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