@article{fdi:010088514,
  title = {{S}caling-up performance-based financing in {B}urkina {F}aso : from {PBF} to user fees exemption strategic purchasing},
  author = {{S}eppey, {M}. and {R}idde, {V}al{\'e}ry and {S}om{\'e}, {P}.{A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground : {N}umerous countries have undertaken performance-based financing ({PBF}) reforms to improve quality and quantity of healthcare services. {H}owever, only few reforms have successfully managed to achieve the different scale-up phases. {I}n {B}urkina {F}aso, a pilot project was implemented, but was put on hold before being scaled. {D}uring 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. {M}ethods : {T}his study's objective is to identify facilitators and barriers to scaling-up for that pilot, based on the {W}orld {H}ealth {O}rganization's ({WHO}'s) theoretical framework. {I}nterviews were conducted in three health centres and in {O}uagadougou to discuss the scale-up with different actors. {T}he software {QDA} {M}iner© was used to help in the framework analysis. {R}esults : {T}he 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.  {T}his 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. {I}ncreased costs during the {PBF}'s implementation gave the impression that the project was too costly and not scalable. {T}he involvement of an important funding agency ({W}orld {B}ank, {WB}) also fed the impression of high costs, which demotivated the actors, especially decision-makers. {C}onclusion : {C}ontextual factors remain central to the implementation of {PBF}, while their evaluation and mitigation have remained unclear. {T}he 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 = {{BURKINA} {FASO}},
  booktitle = {},
  journal = {{I}nternational {J}ournal of {H}ealth {P}olicy and {M}anagement},
  volume = {11},
  numero = {5},
  pages = {670--682},
  ISSN = {2322-5939},
  year = {2020},
  DOI = {10.34172/ijhpm.2020.209},
  URL = {https://www.documentation.ird.fr/hor/fdi:010088514},
}