Seppey Mathieu, Somé Paul-André, Ridde Valéry
École de santé publique, Université de Montréal, Montréal, Canada.
AGIR (Action-Gouvernance-Intégration-Renforcement): Groupe de travail en Santé et Développement, Ouagadougou, Burkina Faso.
J Health Organ Manag. 2021 Feb 5;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-04-2020-0137.
A performance-based financing (PBF) pilot project was implemented in 2011 in Burkina Faso. After more than five years of implementation (data collection in 2016), the project's sustainability was not guaranteed. This study's objective is to assess this project's sustainability in 2016 by identifying the presence/absence of different determinants of sustainability according to the conceptual framework of Seppey (2017).
DESIGN/METHODOLOGY/APPROACH: It uses a case study approach using in-depth interviews with various actors at the local, district/regional and national levels. Participants ( = 37) included health practitioners, management team members, implementers and senior members of health directions. A thematic analysis based on the conceptual framework was conducted, as well as an inductive analysis.
Results show the project's sustainability level was weak according to an unequal presence of sustainability's determinants; some activities are being maintained but not fully routinised. Discrepancies between the project and the context's values appeared to be important barriers towards sustainability. Project's ownership by key stakeholders also seemed superficial despite the implementers' leadership towards its success. The project's objective towards greater autonomy for health centres was also directly confronting the Burkinabe's hierarchical health system.
ORIGINALITY/VALUE: This study reveals many fits and misfits between a PBF project and its context affecting its ability to sustain activities through time. It also underlines the importance of using a conceptual framework in implementing and evaluating interventions. These results could be interesting for decision-makers and implementers in further assessing PBF projects elsewhere.
基于绩效的融资（PBF）试点项目于2011年在布基纳法索实施。经过五年多的实施（2016年进行数据收集），该项目的可持续性无法得到保证。本研究的目的是根据塞佩（2017年）的概念框架，通过确定可持续性不同决定因素的存在与否，评估该项目在2016年的可持续性。
设计/方法/途径：采用案例研究方法，对地方、地区/区域和国家各级的不同行为者进行深入访谈。参与者（n = 37）包括卫生从业人员、管理团队成员、实施人员和卫生部门的高级成员。基于概念框架进行了主题分析以及归纳分析。
结果表明，根据可持续性决定因素的不均衡存在，该项目的可持续性水平较弱；一些活动得以维持，但尚未完全常规化。项目与背景价值观之间的差异似乎是可持续性的重要障碍。尽管实施人员对项目的成功发挥了领导作用，但关键利益相关者对项目的所有权似乎也很表面。该项目实现卫生中心更大自主权的目标也直接与布基纳法索的分级卫生系统相冲突。
原创性/价值：本研究揭示了一个PBF项目与其背景之间的许多契合与不契合之处，这些因素影响了其长期维持活动的能力。它还强调了在实施和评估干预措施时使用概念框架的重要性。这些结果可能对决策者和实施人员在进一步评估其他地方的PBF项目时具有参考价值。
