Implementing performance-based financing in peripheral health centres in Mali: what can we learn from it?

Area of Science:

• Health Systems Research
• Public Health Interventions
• Qualitative Research Methods

Background:

• Sub-Saharan African nations utilize performance-based financing (PBF) to enhance health system performance.
• Limited research exists on PBF implementation in Francophone West Africa.
• This study explores PBF pilot project implementation in Mali's Koulikoro region.

Purpose of the Study:

• To qualitatively understand the implementation process of a performance-based financing pilot project.
• To identify factors influencing the success or challenges of PBF in a specific West African context.

Main Methods:

• A contrasted multiple case study design involving 12 community health centers across three districts.
• Data collection included 161 semi-structured interviews, 69 informal interviews, and 96 non-participant observations.
• Analysis utilized the Consolidated Framework for Implementation Research, adapted to the local context.

Main Results:

• Internal context, particularly leadership and commitment, significantly impacted PBF implementation, with high-performing centers showing stronger engagement.
• Qualified health professionals better understood the intervention, but the short duration limited network and champion development.
• Initial enthusiasm for PBF waned due to implementation schedule delays and payment issues.

Conclusions:

• Performance-Based Financing is a complex intervention affected by multiple actors and diverse contexts.
• Facility-level performance, and internal/external contexts are critical for successful PBF implementation.
• Future research should adopt an interdisciplinary approach combining public health and anthropology for deeper insights.