Scaling-Up Performance-Based Financing in Burkina Faso: From PBF to User Fees Exemption Strategic Purchasing

Document Type : Original Article

Authors

1 Université de Montréal, École de santé publique (ESPUM), Montréal, QC, Canada

2 Research Institute for Sustainable Development, CEPED (IRDUniversité de Paris), Paris, France

3 AGIR (Action-Gouvernance-Intégration- Renforcement; Groupe de travail en Santé et Développement), Ouagadougou, Burkina Faso

Abstract

Background
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.
 
Methods
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.
 
Results
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.
 
Conclusion
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.

Keywords


  1. Fritsche GB, Soeters R, Meessen B. Performance-Based Financing Toolkit. Washington, DC: World Bank; 2014.
  2. Basinga P, Mayaka S, Condo J. Performance-based financing: the need for more research. Bull World Health Organ. 2011;89(9):698-699. doi:10.2471/blt.11.089912
  3. Eichler R, Auxila P, Antoine U, Desmangles B. Haiti: going to scale with a performance incentive model. In: Eichler R, Levine R, The Performance-Based Incentives Working Group, eds. Performance Incentives for Global Health: Potential and Pitfalls. Washington, DC: Center for Global Development; 2009:165-188.
  4. Borghi J, Little R, Binyaruka P, Patouillard E, Kuwawenaruwa A. In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective. Health Aff (Millwood). 2015;34(3):406-414. doi:10.1377/hlthaff.2014.0608
  5. Ngo DK, Sherry TB, Bauhoff S. Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs. Health Policy Plan. 2017;32(1):11-20. doi:10.1093/heapol/czw091
  6. Falisse J-B, Vergeer P, Gebre-Medhin J, et al. Community Results-Based Financing in Health Practice: Reflections on Implementation from Experiences in Six Countries. The Health, Nutrition and Population Global Practice Knowledge Briefs of the World Bank. Washington, DC: World Bank; 2017:4.
  7. Oxman AD, Fretheim A. An Overview of Research on the Effects of Results-Based Financing. Oslo, Norway: The Norwegian Institute of Public Health (NIPH); 2008.
  8. Musgrove P. Financial and other Rewards for Good Performance or Results: A Guided Tour of Concepts and Terms and a Short Glossary. Washington, DC: World Bank; 2011:12.
  9. Grittner AM. Results-Based Financing: Evidence from Performance-Based Financing in the Health Sector. Bonn: German Development Institute; 2013.
  10. Toonen J. Results-Based Financing in Healthcare: Developing an RBF Approach for Healthcare in Different Contexts: The Cases of Mali and Ghana. Amsterdam: Koninklijk Instituut Voor de Tropen; 2012.
  11. Soeters R, Habineza C, Peerenboom PB. Performance-based financing and changing the district health system: experience from Rwanda. Bull World Health Organ. 2006;84(11):884-889.
  12. Soeters R, Peerenboom PB, Mushagalusa P, Kimanuka C. Performance-based financing experiment improved health care in the Democratic Republic of Congo. Health Aff (Millwood). 2011;30(8):1518-1527. doi:10.1377/hlthaff.2009.0019
  13. Renmans D, Holvoet N, Criel B, Meessen B. Performance-based financing: the same is different. Health Policy Plan. 2017;32(6):860-868. doi:10.1093/heapol/czx030
  14. Shroff ZC, Tran N, Meessen B, Bigdeli M, Ghaffar A. Taking results-based financing from scheme to system. Health Syst Reform. 2017;3(2):69-73. doi:10.1080/23288604.2017.1302903
  15. Seppey M, Ridde V, Touré L, Coulibaly A. Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali. Global Health. 2017;13(1):86. doi:10.1186/s12992-017-0307-8
  16. Arur A, Peters D, Hansen P, Mashkoor MA, Steinhardt LC, Burnham G. Contracting for health and curative care use in Afghanistan between 2004 and 2005. Health Policy Plan. 2010;25(2):135-144. doi:10.1093/heapol/czp045
  17. Bloom E, Bhushan I, Clingingsmith D, et al. Contracting for Health: Evidence from Cambodia. Washington, DC: Brookings Institution; 2006.
  18. Meessen B, Kashala JP, Musango L. Output-based payment to boost staff productivity in public health centres: contracting in Kabutare district, Rwanda. Bull World Health Organ. 2007;85(2):108-115. doi:10.2471/blt.06.032110
  19. Basinga P, Gertler PJ, Binagwaho A, Soucat AL, Sturdy J, Vermeersch CM. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation. Lancet. 2011;377(9775):1421-1428. doi:10.1016/s0140-6736(11)60177-3
  20. Shroff ZC, Bigdeli M, Meessen B. From scheme to system (part 2): findings from ten countries on the policy evolution of results-based financing in health systems. Health Syst Reform. 2017;3(2):137-147. doi:10.1080/23288604.2017.1304190
  21. Meessen B, Shroff ZC, Ir P, Bigdeli M. From scheme to system (part 1): notes on conceptual and methodological innovations in the multicountry research program on scaling up results-based financing in health systems. Health Syst Reform. 2017;3(2):129-136. doi:10.1080/23288604.2017.1303561
  22. Shoveller J, Viehbeck S, Di Ruggiero E, Greyson D, Thomson K, Knight R. A critical examination of representations of context within research on population health interventions. Crit Public Health. 2016;26(5):487-500. doi:10.1080/09581596.2015.1117577
  23. Craig P, Di Ruggiero E, Frolich KL, et al. Taking Account of Context in Population Health Intervention Research: Guidance for Producers, Users and Funders of Research. Southampton: National Institute for Health Research (NIHR); 2018.
  24. Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH. "Scaling-out" evidence-based interventions to new populations or new health care delivery systems. Implement Sci. 2017;12(1):111. doi:10.1186/s13012-017-0640-6
  25. World Health Organization (WHO). Nine Steps for Developing a Scaling-Up Strategy. Geneva: WHO; 2010.
  26. World Health Organization (WHO). Scaling Up Projects and Initiatives for Better Health: From Concepts to Practice. WHO Regional Office for Europe; 2016.
  27. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50
  28. Simmons R, Fajans P, Ghiron L. Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes. Geneva: WHO; 2007.
  29. Rogers EM. Diffusion of Innovations. New York: Free Press; 1995:12.
  30. Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11:12. doi:10.1186/s13012-016-0374-x
  31. World Health Organization (WHO). Practical Guidance for Scaling Up Health Service Innovations. WHO; 2009.
  32. Balis LE, Strayer TE 3rd, Ramalingam N, Harden SM. Beginning with the end in mind: contextual considerations for scaling-out a community-based intervention. Front Public Health. 2018;6:357. doi:10.3389/fpubh.2018.00357
  33. Subramanian S, Naimoli J, Matsubayashi T, Peters DH. Do we have the right models for scaling up health services to achieve the Millennium Development Goals? BMC Health Serv Res. 2011;11:336. doi:10.1186/1472-6963-11-336
  34. ExpandNet website. https://expandnet.net/.  Accessed January 17, 2020.
  35. Bicaba A. Évaluation finale de la phase test du financement basé sur les résultats dans les districts sanitaires de Boulsa, Leo et Titao. Rapport Final. Ouagadougou: SERSAP, DEP/MS; 2013.
  36. Ridde V, Turcotte-Tremblay AM, Souares A, et al. Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso. Implement Sci. 2014;9:149. doi:10.1186/s13012-014-0149-1
  37. Steenland M, Robyn PJ, Compaore P, et al. Performance-based financing to increase utilization of maternal health services: evidence from Burkina Faso. SSM Popul Health. 2017;3:179-184. doi:10.1016/j.ssmph.2017.01.001
  38. Zongo A. Mise en oeuvre du financement basé sur les résultats dans le secteur de la santé du Burkina Faso et leçons tirées. Bamako: 2016.
  39. Somé PA, Yaogo M, Zongo S, Turcotte-Tremblay AM, Ridde V. Recherche sur la mise en oeuvre du FBR au Burkina Faso: processus, résultats et défis. Bamako: 2016.
  40. Ministère de la santé du Burkina Faso. Guide de mise en oeuvre du financement basé sur les résultats dans le secteur de la santé. Burkina Faso: Ministère de la santé du Burkina Faso; 2013:344.
  41. Gautier L, Ridde V. Health financing policies in Sub-Saharan Africa: government ownership or donors' influence? a scoping review of policymaking processes. Glob Health Res Policy. 2017;2:23. doi:10.1186/s41256-017-0043-x
  42. Turcotte-Tremblay AM, Gautier L, Bodson O, Sambieni N, Ridde V. Dans les coulisses du pouvoir décisionnel: le rôle des organisations internationales dans l'expansion du financement basé sur les résultats dans les pays à faible et à moyen revenu. En Finir avec le New Public Management; 2016.
  43. Yameogo P. La gratuité des soins au Burkina Faso: un pas décisif vers la couverture sanitaire universelle (CSU). Secrétariat Technique - Couverture Sanitaire Universelle, Ouagadougou; 2019.
  44. Bigeard A. Les principaux dispositifs de couverture du risque maladie d’assurance maladie dans de 7 pays l’Afrique de l’Ouest. Organisation Mondiale de la Santé - Bureau Régional de l’Afrique; 2020.
  45. Caisse Nationale d'Assurance Maladie Universelle (CNAMU). Document de transfert des mesures de gratuité à la Caisse nationale d'assurance maladie universelle (Version provisoire). In: Générale D, ed. Ouagadougou: 2018:49.
  46. Yin RK. Case Study Research: Design and Methods. SAGE Publications; 2013.
  47. Yazan B. Three approaches to case study methods in education: Yin, Merriam, and Stake. Qual Rep. 2015;20(2):134-152.
  48. Hancock T, Barr V, Potvin L. Innovations in Policy and Practice: engaging practitioners as scholars. Can J Public Health. 2015;106(6):e343-352. doi:10.17269/cjph.106.5280
  49. Zombré D, Turcotte-Tremblay AM, Sangaré A, et al. Méthode mixte et participative de sélection d'études de cas multiples pour l'évaluation d'interventions de santé au Burkina Faso et au Mali: de l'étique à l'émique. In: 84e Congrès de l’Acfas;  Gatineau, University of Montreal; May 9-13, 2016.
  50. Green J, Thorogood N. Qualitative Methods for Health Research. Los Angeles: SAGE Publications; 2018.
  51. Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. Journal of Administration & Governance. 2009;4(2):72-79.
  52. Turcotte-Tremblay AM, Gali-Gali IA, De Allegri M, Ridde V. The unintended consequences of community verifications for performance-based financing in Burkina Faso. Soc Sci Med. 2017;191:226-236. doi:10.1016/j.socscimed.2017.09.007
  53. Ridde V, Yaogo M, Zongo S, Somé PA, Turcotte-Tremblay AM. Twelve months of implementation of health care performance-based financing in Burkina Faso: a qualitative multiple case study. Int J Health Plann Manage. 2018;33(1):e153-e167. doi:10.1002/hpm.2439
  54. Zizien ZR, Korachais C, Compaoré P, Ridde V, De Brouwere V. Contribution of the results-based financing strategy to improving maternal and child health indicators in Burkina Faso. Int J Health Plann Manage. 2019;34(1):111-129. doi:10.1002/hpm.2589
  55. Ministère de la santé du Burkina Faso. Plan National de Développement Sanitaire 2011-2020. Ouagadoudou: MoH; 2011:56.
  56. Minstère de la santé du Burkina Faso. Stratégie Nationale de Financement de la Santé pour la couverture sanitaire universelle 2018-2030. Ouagadougou: MoH; 2018:65.
  57. Pluye P. Vers un nouveau modèle théorique du déroulement des programmes : étude de la routinisation des programmes en promotion de la santé. Département de médecine sociale et préventive, Université de Montréal; 2002.
  58. Kiendrébéogo JA, Shroff ZC, Berthé A, Yonli L, Béchir M, Meessen B. Why performance-based financing in Chad failed to emerge on the national policy agenda. Health Syst Reform. 2017;3(2):80-90. doi:10.1080/23288604.2017.1280115
  59. Sieleunou I, Turcotte-Tremblay AM, Yumo HA, et al. Transferring the purchasing role from international to National Organizations during the scale-up phase of performance-based financing in Cameroon. Health Syst Reform. 2017;3(2):91-104. doi:10.1080/23288604.2017.1291218
  60. De Allegri M, Makwero C, Torbica A. At what cost is performance-based financing implemented? novel evidence from Malawi. Health Policy Plan. 2019;34(4):282-288. doi:10.1093/heapol/czz030
  61. Paul E, Lamine Dramé M, Kashala JP, et al. Performance-based financing to strengthen the health system in Benin: challenging the mainstream approach. Int J Health Policy Manag. 2018;7(1):35-47. doi:10.15171/ijhpm.2017.42
  62. Paul E, Sieleunou I, Ridde V. Comment utiliser l'expérience de financement basé sur les résultats (FBR) pour rendre l'achat des services de santé plus stratégique au Bénin? Cahiers réalisme. 2018;15.
  63. Khim K, Ir P, Annear PL. Factors driving changes in the design, implementation, and scaling-up of the contracting of health services in rural Cambodia, 1997-2015. Health Syst Reform. 2017;3(2):105-116. doi:10.1080/23288604.2017.1291217
  64. Petrosyan V, Melkom Melkomian D, Zoidze A, Shroff ZC. National scale-up of results-based financing in primary health care: the case of Armenia. Health Syst Reform. 2017;3(2):117-128. doi:10.1080/23288604.2017.1291394
  65. Zida A, Lavis JN, Sewankambo NK, Kouyate B, Moat K. The factors affecting the institutionalisation of two policy units in Burkina Faso's health system: a case study. Health Res Policy Syst. 2017;15(1):62. doi:10.1186/s12961-017-0228-2
  66. Chimhutu V, Tjomsland M, Songstad NG, Mrisho M, Moland KM. Introducing payment for performance in the health sector of Tanzania- the policy process. Global Health. 2015;11:38. doi:10.1186/s12992-015-0125-9
  67. Castellanet C. Cycle des projets, cadre logique et efficacité des interventions de développement. Paris: Les Editions du Groupe initiatives; 2003.
  68. Zarowsky C. Global health research, partnership, and equity: no more business-as-usual. BMC Int Health Hum Rights. 2011;11(Suppl 2):S1. doi:10.1186/1472-698x-11-s2-s1
  69. Plamondon K, Brisbois B, Dubois-Flynn G, et al. CCGHR Principles for Global Health Research: Promoting Better and more Equitable Health Worldwide through the Production and use of Knowledge. Canadian Coalition for Global Health Research; 2015.
  70. Barnes A, Brown GW, Harman S. Locating health diplomacy through African negotiations on performance-based funding in global health. Journal of Health Diplomacy. 2015;1(3):1-19.
  71. Biesma RG, Brugha R, Harmer A, Walsh A, Spicer N, Walt G. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control. Health Policy Plan. 2009;24(4):239-252. doi:10.1093/heapol/czp025
  72. Paul E, Albert L, Bisala BN, et al. Performance-based financing in low-income and middle-income countries: isn't it time for a rethink? BMJ Glob Health. 2018;3(1):e000664. doi:10.1136/bmjgh-2017-000664
  73. Paul E, Renmans D. Performance-based financing in the heath sector in low- and middle-income countries: Is there anything whereof it may be said, see, this is new? Int J Health Plann Manage. 2018;33(1):51-66. doi:10.1002/hpm.2409
  74. Moullin JC, Sabater-Hernández D, Fernandez-Llimos F, Benrimoj SI. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst. 2015;13:16. doi:10.1186/s12961-015-0005-z
  75. Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan. 2008;23(5):294-307. doi:10.1093/heapol/czn019
  76. Ridde V. Need for more and better implementation science in global health. BMJ Glob Health. 2016;1(2):e000115. doi:10.1136/bmjgh-2016-000115
  77. Van Belle S, van de Pas R, Marchal B. Towards an agenda for implementation science in global health: there is nothing more practical than good (social science) theories. BMJ Glob Health. 2017;2(2):e000181. doi:10.1136/bmjgh-2016-000181
  78. Réseau National de Lutte Anti-corruption (REN-LAC). Etude sur les présomptions de corruption et pratiques assimilées dans le système et les services de santé au Burkina Faso. Ouagadougou: REN-LAC; 2018.
  79. Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Los Angeles: SAGE publications; 2017.

Articles in Press, Corrected Proof
Available Online from 09 November 2020
  • Receive Date: 31 July 2019
  • Revise Date: 08 October 2020
  • Accept Date: 11 October 2020