Miseli Research NGO, Bamako, Mali.
Faculty of Medicine and Odonto-Stomatology, Université des Sciences, des Techniques et des Technologies, Bamako, Mali.
Health Res Policy Syst. 2020 Jun 3;18(1):54. doi: 10.1186/s12961-020-00566-0.
Numerous sub-Saharan African countries have experimented with performance-based financing (PBF) with the goal of improving health system performance. To date, few articles have examined the implementation of this type of complex intervention in Francophone West Africa. This qualitative research aims to understand the process of implementing a PBF pilot project in Mali's Koulikoro region.
We conducted a contrasted multiple case study of performance in 12 community health centres in three districts. We collected 161 semi-structured interviews, 69 informal interviews and 96 non-participant observation sessions. Data collection and analysis were guided by the Consolidated Framework for Implementation Research adapted to the research topic and local context.
Our analysis revealed that the internal context of the PBF implementation played a key role in the process. High-performing centres exercised leadership and commitment more strongly than low-performing ones. These two characteristics were associated with taking initiatives to promote PBF implementation and strengthening team spirit. Information regarding the intervention was best appropriated by qualified health professionals. However, the limited duration of the implementation did not allow for the emergence of networks or champions. The enthusiasm initially generated by PBF quickly dissipated, mainly due to delays in the implementation schedule and the payment modalities.
PBF is a complex intervention in which many actors intervene in diverse contexts. The initial level of performance and the internal and external contexts of primary healthcare facilities influence the implementation of PBF. Future work in this area would benefit from an interdisciplinary approach combining public health and anthropology to better understand such an intervention. The deductive-inductive approach must be the stepping-stone of such a methodological approach.
许多撒哈拉以南非洲国家尝试了基于绩效的融资（PBF），以改善卫生系统绩效。迄今为止，很少有文章研究过这种复杂干预措施在西非法语国家的实施情况。这项定性研究旨在了解马里库里克罗地区实施 PBF 试点项目的过程。
我们对三个地区的 12 个社区卫生中心进行了绩效对比多案例研究。我们收集了 161 次半结构化访谈、69 次非正式访谈和 96 次非参与观察会议。数据收集和分析以适应研究主题和当地背景的实施研究综合框架为指导。
我们的分析表明，PBF 实施的内部环境在实施过程中起着关键作用。表现良好的中心比表现不佳的中心更强烈地行使领导权和承诺。这两个特征与采取主动行动促进 PBF 实施和加强团队精神有关。有关干预措施的信息最好由合格的卫生专业人员掌握。然而，实施的有限时间不允许出现网络或拥护者。PBF 最初产生的热情很快就消失了，主要是由于实施时间表和支付方式的延迟。
PBF 是一种复杂的干预措施，其中许多行为体在不同的背景下进行干预。初级保健机构的初始绩效水平以及内部和外部环境影响 PBF 的实施。该领域的未来工作将受益于公共卫生和人类学相结合的跨学科方法，以更好地理解这种干预措施。演绎归纳法必须是这种方法途径的基石。
