Sustainability determinants of the Burkinabe performance-based financing project

Area of Science:

• Global Health
• Health Systems Strengthening
• Health Economics

Background:

• Performance-based financing (PBF) is a key strategy for improving healthcare delivery.
• Assessing the sustainability of PBF initiatives is critical for long-term impact.
• The Burkina Faso PBF pilot project, initiated in 2011, required evaluation after over five years.

Purpose of the Study:

• To assess the sustainability of the Burkina Faso PBF pilot project in 2016.
• To identify determinants of sustainability using Seppey et al.'s (2017) conceptual framework.
• To understand the project's fit within the local health system context.

Main Methods:

• A case study approach was employed.
• In-depth interviews were conducted with 37 participants across local, district, and national levels.
• Thematic and inductive analyses were performed based on the conceptual framework.

Main Results:

• The project exhibited weak sustainability, with activities not fully routinized.
• Significant barriers included discrepancies between project values and the local context.
• Superficial stakeholder ownership and conflict with the hierarchical health system hindered sustainability.

Conclusions:

• Misfits between the PBF project and its context significantly impacted activity sustainability.
• The study highlights the importance of conceptual frameworks for PBF implementation and evaluation.
• Findings offer insights for decision-makers and implementers of PBF projects globally.