@article{fdi:010077775,
  title = {{H}ow does performance-based financing affect the availability of essential medicines in {C}ameroon ? : a qualitative study},
  author = {{S}ieleunou, {I}. and {T}urcotte-{T}remblay, {A}. {M}. and {D}e {A}llegri, {M}. and {F}otso, {J}. {C}. {T}. and {Y}umo, {H}. {A}. and {T}amga, {D}. {M}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{P}erformance-based financing ({PBF}) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. {A}lthough a few studies have examined the effects of {PBF} on the availability of essential medicines ({EM}s) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. {O}ur research aimed to explore how {PBF} in {C}ameroon influenced the availability of {EM}s, and to understand the pathways leading to the experiential dimension related with the observed changes. {T}he design was an exploratory qualitative study. {D}ata were collected through in-depth interviews, using semi-structured questionnaires. {K}ey informants were selected using purposive sampling. {T}he respondents (n=55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. {A}ll interviews were recorded, transcribed and analysed using qualitative data analysis software. {T}hematic analysis was performed. {O}ur findings suggest that the {PBF} programme improved the perceived availability of {EM}s in three regions in {C}ameroon. {T}he change in availability of {EM}s experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. {H}owever, a sequence of challenges, including delays in {PBF} payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. {T}he participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. {T}he study highlights that some specific dimensions of {PBF}, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.},
  keywords = {{P}erformance-based financing ; essential medicines ; essential drugs ; {C}ameroon ; {CAMEROUN}},
  booktitle = {},
  journal = {{H}ealth {P}olicy and {P}lanning},
  volume = {34},
  numero = {3},
  pages = {4--19},
  ISSN = {0268-1080},
  year = {2019},
  DOI = {10.1093/heapol/czz084},
  URL = {https://www.documentation.ird.fr/hor/fdi:010077775},
}