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Seydou Traoré1, Samira Guennif2, Léon G Blaise Savadogo3

  • 1Department of Public Health, Nazi Boni University of Bobo-Dioulasso, Burkina Faso. IRIS, UMR 8156 CNRS, Inserm, EHESS/Université Sorbonne-Paris-Nord, France.

Sante Publique (Vandoeuvre-Les-Nancy, France)
|June 23, 2025
PubMed
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Results-based financing (RBF) in Burkina Faso showed mixed results and did not advance universal health coverage (UHC) due to a lack of local context integration. The program

Area of Science:

  • Health policy analysis
  • Institutional change theory
  • Universal Health Coverage (UHC) implementation

Context:

  • Results-based financing (RBF) was introduced in Burkina Faso in 2011 as a strategy for health system improvement and UHC.
  • RBF was perceived as an externally driven policy, supported by the World Bank and implemented by actors outside the Ministry of Health.
  • The program was suspended in 2018 without national rollout due to limited adoption by key stakeholders.

Purpose:

  • To analyze the introduction and contribution of RBF to Burkina Faso's UHC efforts.
  • To understand the causes, mechanisms, and outcomes of institutional change related to RBF implementation.
  • To evaluate RBF's alignment with national health system structures and UHC goals.

Summary:

  • RBF implementation in Burkina Faso faced challenges due to its external nature and lack of integration with the existing health system.
Keywords:
Burkina Faso.health care systeminstitutional changeresults-based financinguniversal health coverage

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  • The program's impact on health indicators and progress towards UHC was limited.
  • Key actors within the health system did not adopt RBF, leading to its discontinuation.
  • Impact:

    • The study underscores the critical importance of considering local context in designing and implementing health financing reforms.
    • Failure to integrate RBF with local institutional structures hindered its effectiveness and sustainability.
    • The findings offer lessons for future health system strengthening initiatives aiming for UHC.