How is the discourse of performance-based financing shaped at the global level? A poststructural analysis

Area of Science:

• Global Health Policy
• Health Systems Research
• Policy Diffusion Studies

Background:

• Performance-based financing (PBF) has rapidly spread in low- and middle-income countries.
• Existing research on PBF implementation and effects leaves a gap in understanding its diffusion processes.
• Discursive processes are critical to policy diffusion, shaping the political debate around PBF.

Purpose of the Study:

• To analyze the construction of the global discourse on Performance-based financing (PBF).
• To investigate how problem representations embedded in discourse influence PBF diffusion.
• To apply Bacchi's poststructural approach to understand PBF's global discourse.

Main Methods:

• Qualitative data collection including 57 in-depth interviews and 10 observation notes.
• Content analysis of transcribed qualitative data using QDAMiner©.
• Application of diffusion entrepreneur frameworks and Bacchi's poststructural approach for coding and analysis.

Main Results:

• Global diffusion entrepreneurs actively shape and disseminate problem representations of PBF.
• These representations align with diffusion entrepreneurs' beliefs and interests, often conflicting with others.
• Entrepreneurs employ strategies like policy experimentation and emulation to spread PBF.

Conclusions:

• Bacchi's approach effectively analyzes global health problem representations and diffusion strategies.
• Further research should explore the motivations and resources of actors shaping global health discourses.
• Understanding the construction of global health discourses is crucial for effective policy diffusion.