TY - JOUR ID - 3796 TI - Transnational Networks’ Contribution to Health Policy Diffusion: A Mixed Method Study of the Performance-Based Financing Community of Practice in Africa JO - International Journal of Health Policy and Management JA - IJHPM LA - en SN - AU - Gautier, Lara AU - De Allegri, Manuela AU - Ridde, Valéry AD - Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada AD - Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany AD - CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, Paris, France Y1 - 2021 PY - 2021 VL - 10 IS - 6 SP - 310 EP - 323 KW - Transnational Policy Networks KW - Communities of Practice KW - Social Network Analysis KW - Semantic Analysis KW - Performance-Based Financing KW - Sub-Saharan Africa DO - 10.34172/ijhpm.2020.57 N2 - Background Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA).   Methods Informed by the diffusion entrepreneurs’ (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP’s online discussion forum (n = 1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n = 40) and data extracted from the CoP’s key documentation (n = 17).   Results CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time.   Conclusion This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF. UR - https://www.ijhpm.com/article_3796.html L1 - https://www.ijhpm.com/article_3796_f575e09adaea4e59ea452b1f24489da9.pdf ER -