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dc.contributor.authorDe Allegri, Manuela
dc.contributor.authorBertone, Maria Paola
dc.contributor.authorMcMahon, Shannon
dc.contributor.authorChare, Idrissou Mounpe
dc.contributor.authorRobyn, Paul Jacob
dc.date.accessioned2018-06-29T22:03:29Z
dc.date.available2018-06-29T22:03:29Z
dc.date.issued2018-03-25
dc.identifierER5290
dc.identifier.citationDe Allegri, M., Bertone, M., McMahon, S., Chare, I. & Robyn, P. (2018) Unraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon, BMJ Global Health, vol. 3, , pp. e000693,
dc.identifier.issn2059-7908
dc.identifier.urihttp://dx.doi.org/10.1136/bmjgh-2017-000693
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/5290
dc.description.abstractIntroduction Performance-based financing (PBF) has acquired increased prominence as a means of reforming health system purchasing structures in low-income and middle-income countries. A number of impact evaluations have noted that PBF often produces mixed and heterogeneous effects. Still, little systematic effort has been channelled towards understanding what causes such heterogeneity, including looking more closely at implementation processes. Methods Our qualitative study aimed at closing this gap in knowledge by attempting to unpack the mixed and heterogeneous effects detected by the PBF impact evaluation in Cameroon to inform further implementation as the country scales up the PBF approach. We collected data at all levels of the health system (national, district, facility) and at the community level, using a mixture of in-depth interviews and focus group discussions. We combined deductive and inductive analytical techniques and applied analyst triangulation. Results Our findings indicate that heterogeneity in effects across facilities could be explained by preexisting infrastructural weaknesses coupled with rigid administrative processes and implementation challenges, while heterogeneity across indicators could be explained by providers' practices, privileging services where demand-side barriers were less substantive. Conclusion In light of the country's commitment to scaling up PBF, it follows that substantial efforts (particularly entrusting facilities with more financial autonomy) should be made to overcome infrastructural and demand-side barriers and to smooth implementation processes, thus, enabling healthcare providers to use PBF resources and management models to a fuller potential.
dc.format.extente000693
dc.publisherBMJ
dc.relation.ispartofBMJ Global Health
dc.titleUnraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon
dc.typearticle
dcterms.accessRightspublic
dc.description.facultysch_iih
dc.description.volume3
dc.identifier.doihttp://10.1136/bmjgh-2017-000693
dc.description.ispublishedpub
dc.description.eprintid5290
rioxxterms.typearticle
refterms.dateAccepted2018-02-14
refterms.dateFCA2018-04-02
refterms.dateFCD2018-04-02
qmu.authorBertone, Maria Paola
qmu.centreInstitute for Global Health and Development
dc.description.statuspub
dc.description.number2


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