Université de Montréal, École de santé publique (ESPUM), Montréal, QC, Canada.
Research Institute for Sustainable Development, CEPED (IRDUniversité de Paris), Paris, France.
Int J Health Policy Manag. 2022 May 1;11(5):670-682. doi: 10.34172/ijhpm.2020.209.
Numerous countries have undertaken performance-based financing (PBF) reforms to improve quality and quantity of healthcare services. However, only few reforms have successfully managed to achieve the different scale-up phases. In Burkina Faso, a pilot project was implemented, but was put on hold before being scaled. During the writing of this article, discussions to scale-up were still ongoing on a national strategic purchasing strategy within a government led user fee exemption policy.
This study's objective is to identify facilitators and barriers to scaling-up for that pilot, based on the World Health Organization's (WHO's) theoretical framework. Interviews were conducted in three health centres and in Ouagadougou to discuss the scale-up with different actors. The software QDA Miner© was used to help in the framework analysis.
The low involvement of some key stakeholders (mainly decision-makers) and the unstable context hindered ownership of the project, thus its priority on the political agenda. PBF reform therefore lost its momentum to the benefit of a user fee exemption policy. This latter program was seen to be more beneficial since it addressed access to healthcare services, in comparison to service quality, which was the PBF's relative advantage. A scale-up of some PBF elements (eg, strategic purchasing tools) is however still in discussion in 2019, but would be integrated within the user fee exemption program. Increased costs during the PBF's implementation gave the impression that the project was too costly and not scalable. The involvement of an important funding agency (World Bank, WB) also fed the impression of high costs, which demotivated the actors, especially decision-makers.
Contextual factors remain central to the implementation of PBF, while their evaluation and mitigation have remained unclear. The participation of key actors in scaling-up operations and the use of social science as tools to better understand the context is therefore primordial.
许多国家已经开展了基于绩效的融资（PBF）改革，以提高医疗服务的质量和数量。然而，只有少数改革成功地实现了不同的扩展阶段。在布基纳法索，实施了一个试点项目，但在扩大规模之前被搁置。在本文撰写期间，政府主导的免除使用费政策下，正在就国家战略采购战略进行扩大规模的讨论。
本研究的目的是根据世界卫生组织（WHO）的理论框架，确定该试点项目扩大规模的促进因素和障碍。在三个卫生中心和瓦加杜古进行了访谈，与不同的利益相关者讨论了扩大规模的问题。使用 QDA Miner©软件帮助进行框架分析。
一些关键利益相关者（主要是决策者）的参与度低以及不稳定的环境阻碍了项目的所有权，因此其在政治议程上的优先级较低。PBF 改革因此失去了动力，转而支持免除使用费政策。后者被认为更有益，因为它解决了获得医疗保健服务的问题，而不是 PBF 的相对优势——服务质量。然而，2019 年仍在讨论扩大一些 PBF 要素（例如，战略采购工具），但将纳入免除使用费计划。在 PBF 实施过程中增加的成本给人留下了项目成本过高且不可扩展的印象。一个重要的资助机构（世界银行，WB）的参与也让人觉得成本过高，这使利益相关者，特别是决策者失去了积极性。
背景因素仍然是实施 PBF 的核心，而对其进行评估和缓解的工作仍不明确。关键利益相关者参与扩大规模的行动以及利用社会科学作为更好地理解背景的工具至关重要。
