Abstract
Since its commencement in Rwanda in 2006, the study ofperformance-based financing (PBF) in Africa has focusedresearch attention on its effects regarding improving thehealth care system or achieving health-related MillenniumDevelopment Goals (MDGs). Similarly, critics of PBF haveconcentrated more on its inability to transform structuralindicators of the health system positively and sustainably.So far, the scientific literature has not sufficiently exploredthe implications concerning the ideological and operationalmutations that the PBF is operating. This study investigatesthese aspects of PBF in conception and operationalization ofpublic health intervention. The concept of depoliticization ofpublic health action is proposed in this analysis to describe thecapacity of the PBF to redraw health policy from the realmof political and State intervention, and from the primacy ofpublic sector to field of market-based competition betweenGovernment sponsored and non-State actors.
Highlights
For a decade, Pay for Performance (P4P) has asserted itself as the new instrument for health system reform in sub-Saharan Africa (SSA) (Soeters;Vroeg, 2011)
While false reporting refers to the fact that unverifiable information and declared in order to secure positive assessments, cheating relates to the manipulation of data.Critics are challenging the effectiveness of P4P, which was used by international donors to justify its dissemination across SSA.Among the most severe critics are those stressing the weakening of the health system by Performance-Based Financing (PBF) in Africa (Paul et al, 2017)in the sense that the opportunity to develop an independent and self-sustain health system is missed out;or the development of perverse effects among health professionals (Ireland; Paul; Dujardin, 2011; Shen et al, 2017)
Stimulating competition by promoting market access to other drug distributors. (Aoudi et al, 2017). These recommendations point to a blockage facing the scheme in Cameroon where both national scale up and institutional ownership are in jeopardy because important public policy and decision makers have been ousted throughout the process.The effort to get them involved afterward has proven to be difficult as they see the PBF scheme as a threat to their policy influence and power.This difficulty could have been prevented by a better mapping of all stakeholders and key players in the policymaking process of recipient countries, and their inclusion right from the beginning of the processes, e.i. from the design phase
Summary
Pay for Performance (P4P) has asserted itself as the new instrument for health system reform in sub-Saharan Africa (SSA) (Soeters;Vroeg, 2011). Implementing PBF in all regions of Cameroon; Establishing a legal and institutional framework to protect health facility managers under These recommendations point to a blockage facing the scheme in Cameroon where both national scale up and institutional ownership are in jeopardy because important public policy and decision makers have been ousted throughout the process.The effort to get them involved afterward has proven to be difficult as they see the PBF scheme as a threat to their policy influence and power.This difficulty could have been prevented by a better mapping of all stakeholders and key players in the policymaking process of recipient countries, and their inclusion right from the beginning of the processes, e.i. from the design phase. The desire to rally them to the cause later seems much more challenging than their inclusion at the initial stage of the process (Shroff et al, 2017)
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