References of "Paul, Elisabeth"
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See detailPerformance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach
Paul, Elisabeth ULiege; Dramé, Mohamed L.; Kashala, Jean-Pierre et al

in International Journal of Health Policy and Management (2017), 6

Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian ... [more ▼]

Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC) followed suit through a health system strengthening (HSS) project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods: An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results: Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms), as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and sustainability issues are also discussed. Conclusion: BTC’s alternative PBF approach is both promising in terms of effects, ownership and sustainability, and less resource consuming. This experience testifies that PBF is not a uniform or rigid model, and opens the policy ground for recipient governments to put their own emphasis and priorities and design ad hoc models adapted to their context specificities. However, integrating PBF within the normal functioning of local health systems, in line with other reforms, is a big challenge. [less ▲]

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See detailPerformance-Based Financing in the heath sector in low- and middle-income countries: Is there anything whereof it may be said, See, this is new?
Paul, Elisabeth ULiege; Renmans, Dimitri

in International Journal of Health Planning and Management (2017)

Whereas performance‐based financing (PBF) is nowdeveloping fast in the health sector in low‐ and middle‐income countries and is presented an innovative approach—concomitantly, subject to a separate ... [more ▼]

Whereas performance‐based financing (PBF) is nowdeveloping fast in the health sector in low‐ and middle‐income countries and is presented an innovative approach—concomitantly, subject to a separate research stream—it sharesmany features of the “managing for results” (MfR) and performance‐based budgeting (PBB) currents that have existed for decades. In this paper, we first argue that PBF as currently developed in the health sector in low‐ and middle‐income countries shares many features and thus can be viewed as an avatar of MfR andmore precisely PBB. Secondly,we drawlessons fromthe literature on MfR and PBB so as to (1) better apprehend PBF conceptually and (2) avoid pitfalls and better design PBF schemes in practice. We argue that the lessons from the theoretical and empirical literature on MfR and PBB offer interesting insights to feed into a “theory of change” of PBF, enabling to analyse critical aspects and better design PBF schemes. Moreover, it is hoped that just like MfR processes have been demonstrated as having the potential to boost individual performance not only through links with financial incentives but also through acting on other sources of motivation, one can demonstrate more accurately by which mechanisms the various elements of the PBF package can help improve health sector results. [less ▲]

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See detailLa couverture santé universelle dans les pays à revenus faibles et intermédiaires : analyses économiques
Paul, Elisabeth ULiege; Bodson, Oriane ULiege; Ridde, Valéry et al

in Reflets et Perspectives de la Vie Economique (2016), 1

Les pays à revenu faible et intermédiaire sont confrontés à des besoins de financement élevés pour assurer une couverture santé universelle (CSU) permettant à chacun d'avoir accès à des services de santé ... [more ▼]

Les pays à revenu faible et intermédiaire sont confrontés à des besoins de financement élevés pour assurer une couverture santé universelle (CSU) permettant à chacun d'avoir accès à des services de santé de qualité sans encourir de difficultés financières. Cet article tente de montrer comment l'analyse économique peut être mobilisée pour identifier des stratégies utiles pour tendre vers la CSU. Trois axes complémentaires où l'analyse économique a une plus-value sont présentés : i) la mobilisation des ressources et l'équité verticale ; ii) l'amélioration de l'efficacité dans l'allocation des ressources et l'équité horizontale ; iii) la gestion opérationnelle des ressources, en particulier à travers le financement basé sur les résultats (efficience). Pour chacun, nous présentons un bref état des lieux de l'état des connaissances et évoquons quelques perspectives de recherche. [less ▲]

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See detailPerformance-Based Aid: Why it will probably not meet promises
Paul, Elisabeth ULiege

in Development Policy Review (2015), 33(3),

Performance-based aid (PBA) is increasingly advocated as a way to improve development aid effectiveness through resolving incentive issues inherent in aid relationships. Some donors use PBA together with ... [more ▼]

Performance-based aid (PBA) is increasingly advocated as a way to improve development aid effectiveness through resolving incentive issues inherent in aid relationships. Some donors use PBA together with performance-based financing arrangements within partner countries. Expectations from PBA are high – yet, while its rationale may look appealing, it is grounded on a restrictive model and flawed when taking account of real-world context. A number of problems associated to PBA have already been advanced as jeopardising its success. More fundamentally, one may question the mere appropriateness of PBA to provide incentives all along the chain from recipient governments to those who are supposed to produce results. Thus believing that PBA can have a mechanistic trickle-down incentive effect seems an illusion. [less ▲]

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See detailStakeholder incentives and aid effectiveness: A case study in the health district of Kayes in Mali
Devahive, Eva; Paul, Elisabeth ULiege; Samaké, Salif et al

in Journal of Development Studies (2015)

This case study analyses how far donors implement aid effectiveness principles at health district level in Mali, and why. It shows that not all aid effectiveness principles are implemented at a similar ... [more ▼]

This case study analyses how far donors implement aid effectiveness principles at health district level in Mali, and why. It shows that not all aid effectiveness principles are implemented at a similar degree. Most projects have limited impact on health services, but many programmes supported by donors offer positive opportunities for health system strengthening. The representations of different categories of stakeholders diverge – notably, regarding the role of different actors in service provision. A number of consistent strategic logics influence actors’ behaviour. We show that while many donors have committed at global level to respect aid effectiveness principles, implementation lags behind. [less ▲]

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See detailLocal Stakeholders’ Perceptions About the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts
Paul, Elisabeth ULiege; Sossouhounto, Nadine; Eclou, Dieudonné

in International Journal of Health Policy and Management (2014), 3

Background: Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study ... [more ▼]

Background: Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. Methods: The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis. Results: The Ministry of Health (MoH) strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak — and ‘blurred’ — to have a lasting inciting effect. It rather seems that PBF motivates health workers through other elements of its ‘package’, especially formative supervisions. Conclusion: If the global picture is quite positive, several issues could jeopardise the success of PBF. It appears crucial to reduce the perceived unfairness in the system, notably through enhancing all facilities’ capacities to ensure they are in line with national norms, as well as to ensure financial and institutional sustainability of the system. [less ▲]

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See detailComment on : “Do Sector-Wide Approaches for health aid delivery lead to ‘donorflight’? A comparison of 46 low-income countries” by Rohan Sweeney, Duncan Mortimer, and David W. Johnston
Paul, Elisabeth ULiege; Porignon, Denis ULiege; Dujardin Bruno, et al

in Social Science & Medicine (2014)

Critique of a published paper on health SWAps. We question the core of the article, as it is to us based on wrong assumptions, a maladapted design, questionable data, and it leads to dangerous conclusions.

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See detailL'efficacité de l'aide en santé en Afrique de l'Ouest: maintenant plus que jamais
Paul, Elisabeth ULiege; Eclou, Dieudonné; Sossouhounto, Nadine et al

in Global Health Promotion (2013)

La préoccupation d'améliorer l'efficacité de l'aide au développement dans le secteur de la santé est plus que jamais d’actualité. L'approche sectorielle permet d'obtenir des améliorations importantes à ce ... [more ▼]

La préoccupation d'améliorer l'efficacité de l'aide au développement dans le secteur de la santé est plus que jamais d’actualité. L'approche sectorielle permet d'obtenir des améliorations importantes à ce niveau et connaît un renouveau à travers le Partenariat International pour la Santé et initiatives liées (IHP+). Dans ce commentaire, nous montrons comment l'IHP+ a été mis en œuvre dans trois pays ouest-africains francophones: le Bénin, le Burkina Faso et le Mali. La dynamique existant dans le secteur de la santé dans chacun des pays a influencé la façon dont l'IHP+ s’y est traduit. Au-delà de ces dynamiques différentes, l'IHP+ a permis de renforcer la place des plans et dispositifs nationaux de coordination comme plateforme de suivi-évaluation et de redevabilité du secteur santé. Toutefois, certaines pratiques contraires aux principes de l'efficacité de l'aide perdurent encore, en particulier le manque d'alignement sur les systèmes de gestion nationaux et le manque de prévisibilité de l'aide. [less ▲]

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See detailAid for health in times of political unrest in Mali: Does donors' way of intervening allow protecting people's health?
Paul, Elisabeth ULiege; Samaké, Salif; Berthé Issa Bara, Issa et al

in Health Policy & Planning (2013)

Mali has long been a leader in francophone Africa in developing systems aimed at improving aid effectiveness, especially in the health sector. But following the invasion of the Northern regions of the ... [more ▼]

Mali has long been a leader in francophone Africa in developing systems aimed at improving aid effectiveness, especially in the health sector. But following the invasion of the Northern regions of the country by terrorist groups and a coup in March 2012, donors suspended official development assistance, except for 20 support to NGOs and humanitarian assistance. They resumed aid after transfer of power to a civil government, but this was not done in a harmonized framework. This article describes and analyses how donors in the health sector reacted to the political unrest in Mali. It shows that despite its long sector-wide approach experience and international agreements to respect aid effectiveness principles, donors have not been able to intervene in view of safeguarding the investments of co-operation in the past decade, and of protecting the health systemss functioning. They reacted to the political unrest on a bilateral basis, stopped working with their ministerial partners, interrupted support to the health system which was still expected to serve populations needs and took months before organizing alternative and only partial solutions to resume aid to the health sector. The Malian example leads to a worrying conclusion: while protecting the health system's achievements and functioning for the population should be a priority, and while harmonizing donors' interventions seems the most appropriate way for that purpose, donors' management practices do not allow for reacting adequately in times of unrest. The article concludes by a number of recommendations. [less ▲]

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See detailResults from the implementation of aid effectiveness principles in the health sector in Mali
Paul, Elisabeth ULiege; Ireland, Megan; Martini, Jessica et al

in Journal of Public Health Policy (2013), 34

The international community holds high expectations for aid producing demonstrable results in the health sector, at the global and developing country levels. Yet, measuring the effectiveness of aid ... [more ▼]

The international community holds high expectations for aid producing demonstrable results in the health sector, at the global and developing country levels. Yet, measuring the effectiveness of aid presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward learning whether and how practices have changed. We present a framework for measuring the results of implementing aid effectiveness principles at three levels: implementation process, health system strengthening, and outcomes/impact. We developed this framework in the context of monitoring results on the effectiveness of the aid agenda in the health sector in Mali. Despite some changes in behavior that resulted in increased aid effectiveness and improved results at system and outcome levels, overall, the aid effectiveness principles have not been fully implemented. Thus expectations in terms of health outcomes should be realistic. [less ▲]

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See detailDeveloping national health sector monitoring and accountability platforms. The opportunity of IHP+ in Benin, Burkina Faso, Mali and Senegal
Paul, Elisabeth ULiege; Akpamoli, Alphonse; Ba, Amadou D. et al

Conference (2012, November 01)

There is now growing consensus about the importance of building and strengthening national monitoring platforms in order to facilitate the evaluation of large-scale health programmes and initiatives in ... [more ▼]

There is now growing consensus about the importance of building and strengthening national monitoring platforms in order to facilitate the evaluation of large-scale health programmes and initiatives in low- and middle-income countries [see the paper published in 2010 in The Lancet by Victora et al.]. This is also crucial for improving accountability, which is defined by the United Nations' Commission on Information and Accountability for Women's and Children's Health as a cyclical process of monitoring, review, and (remedial) action. The International Health Partnership and related initiatives (IHP+), World Health Organization and other partners have recently developed guidelines to support country-led platforms for monitoring, evaluation and review of national health strategies. The national Compacts promoted in the framework of IHP+ offer an excellent opportunity to foster the development of such country-led platforms for information and accountability. Indeed, a Compact formalises the commitments of the recipient government and health sector partners to increase financing efforts in the health sector, to respect aid effectiveness principles and to support the national health policy and strategies in a common planning, coordination, and monitoring & evaluation framework. IHP+ is also closely connected to initiatives such as the Health Metrics Network that aims to improve the quality of health information in developing countries. We propose to analyse how the Ministries of Health in four Francophone Western African countries (Benin, Burkina Faso, Mali and Senegal) have seized the opportunity of IHP+ to strengthen their monitoring and accountability platforms, and assess what further actions could be taken in the future. We present a comparative analysis grid filled on the basis of the experience of the co-authors in supporting the process in the four countries. This composes the first step of an on-going research and experience sharing project supported by GRAP-PA Santé. [less ▲]

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See detailMotivation of human resources for health: a case study at rural district level in Tanzania
Zinnen, Véronique; Paul, Elisabeth ULiege; Mwisongo, Aziza et al

in International Journal of Health Planning and Management (2012), 27(4), 327-347

An increasing number of studies explore the association between financial and non-financial incentives and the retention of health workers in developing countries. This study aims to contribute to ... [more ▼]

An increasing number of studies explore the association between financial and non-financial incentives and the retention of health workers in developing countries. This study aims to contribute to empirical evidence on human resource for health motivation factors to assist policy makers in promoting effective and realistic interventions. A cross-sectional survey was conducted in four rural Tanzanian districts to explore staff stability and health workers' motivation. Data were collected using qualitative and quantitative techniques, covering all levels and types of health facilities. Stability of staff was found to be quite high. Public institutions remained very attractive with better job security, salary and retirement benefits. atisfaction over working conditions was very low owing to inadequate working equipment, work overload, lack of services, difficult environment, favouritism and 'empty promotions'. Positive incentives mentioned were support for career development and supportive supervision. Attracting new staff in rural areas appeared to be more difficult than retaining staff in place. The study concluded that strategies to better motivate health personnel should focus on adequate remuneration, positive working and living environment and supportive management. However, by multiplying health facilities, the latest Tanzanian human resource for health plan could jeopardize current positive results. [less ▲]

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See detailForeign Aid Transaction Costs: What are they and when are they minimised?
Paul, Elisabeth ULiege; Vandeninden, Frieda ULiege

in Development Policy Review (2012), 30(3),

'Transaction costs' are commonly referred to in the recent literature on aid effectiveness. Aid transaction costs, however, have been neither consistently defined nor measured. This article defines aid ... [more ▼]

'Transaction costs' are commonly referred to in the recent literature on aid effectiveness. Aid transaction costs, however, have been neither consistently defined nor measured. This article defines aid transaction costs as all the economic costs associated with aid management that add no value to aid delivery. This enables the 'net' transaction costs that should be minimised to be identified. An analytical framework is then developed for assessing these costs. This allows the effectiveness of different aid modalities to be compared, according to the characteristics of the aid transaction. The article shows that the choice of aid modality should depend on these characteristics and, therefore, that the minimisation of transaction costs should not be an end in itself. [less ▲]

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See detailThe evaluation of the Paris declaration on aid effectiveness: what does it tell us? What results for the health sector?
Martini, Jessica; Paul, Elisabeth ULiege; Ireland, Megan et al

in Tropical Medicine & International Health [=TM & IH] (2011), 16(S1), 331

Five years after the signing of the Paris Declaration on aid effectiveness by donors and developing countries, there is a climate of high expectations about the results achieved and the impact at sector ... [more ▼]

Five years after the signing of the Paris Declaration on aid effectiveness by donors and developing countries, there is a climate of high expectations about the results achieved and the impact at sector level. Several evaluations and monitoring surveys have been conducted by the OECD to measure progress made so far in implementing the principles of ownership, alignment, harmonisation, results and mutual accountability. For the health sector, results have also been documented in the context of the International Health Partnership (IHP+). We critically reviewed all the aid effectiveness surveys and evaluations published since 2005 by the OECD and IHP+ so as to analyse what results have been achieved so far as well as the relevance of the frameworks used. To date, results of the implementation of the Paris Declaration are mixed. In the health sector, good progress has been achieved in terms of country ownership and coordination, while alignment and use of country systems, managing for results and mutual accountability lag behind. However, the results recorded often reflect different interpretation of the indicators depending on the respondent, the data available or the time of the survey. Making generalisations is therefore difficult and comparisons between country surveys and over time may not be appropriate. Linking progress in aid effectiveness with improvements in health outcomes is also controversial. Results from the evaluations of the Paris Declaration should be used with caution in the current debate about aid effectiveness. What do the indicators used actually tell us? How realistically can aggregated scores reflect complex issues such as aid effectiveness in different countries, by different donors and over time? Improved evaluation is clearly needed. Data collection should be more rigorous and at sector level contextual factors and behaviour change should be better assessed, over a longer term and through more qualitative comprehensive methods. [less ▲]

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See detailWhat results can be expected from the agenda for aid effectiveness?
Paul, Elisabeth ULiege; Ireland, Megan; Martini, Jessica et al

Conference (2011, October)

Introduction: Currently there is a climate of high expectations with regard to producing demonstrable results of aid effectiveness in the health sector. Yet, commitments to aid effectiveness have only ... [more ▼]

Introduction: Currently there is a climate of high expectations with regard to producing demonstrable results of aid effectiveness in the health sector. Yet, commitments to aid effectiveness have only partially been implemented so far. Existing evaluation frameworks developed in the context of the Paris Declaration and International Health Partnership (IHP+) are not sufficiently geared toward whether and how practices have changed at donor, central and operational levels, and thus how reforms have actually been implemented. Measuring their impact also presents methodological challenges. Methods: This communication aims to present an outline of how to measure results from the agenda for aid effectiveness. It argues that it should be carried out at three levels. A first, critical step for evaluating the results from the Paris Declaration and IHP+ is to evaluate its implementation process and the direct effects it has had on changes in behaviour for all stakeholders (donors, government, service providers, etc.). A second level of evaluation is to assess how far donor support and implementation of Paris principles have contributed to health system strengthening (HSS) up to the level of service delivery. The third level where improvement is expected and should be measured is at health outcome/status level. Qualitative methods can help to understand what constraining factors are, what reforms have led to improvements and why, and finally the impact on population health. Results: This three-level assessment was made in Mali. We found that some progress and positive changes have been observed in recent years that can be attributed to the agenda for aid effectiveness; outcome and impact indicators have also improved in the past years. However, donors have not fulfilled all their commitments. Conclusion: Whilst changes in behaviour and practices are occurring, adherence to the principles of aid effectiveness is far from complete, thus expectations should be realistic. [less ▲]

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See detailComparative analysis of two different approaches to putting IHP+ into practice: Mali and Benin
Paul, Elisabeth ULiege; Berthé, Issa; Samaké, Salif

Conference (2011, October)

Introduction: The International Health Partnership and related initiatives (IHP+) seeks to achieve better results by mobilising development partners around a single country-led national health strategy ... [more ▼]

Introduction: The International Health Partnership and related initiatives (IHP+) seeks to achieve better results by mobilising development partners around a single country-led national health strategy, guided by the principles of the Paris Declaration on Aid Effectiveness. At country level, the IHP+ materializes through the preparation, signature, implementation, and monitoring and evaluation of a "Country Compact" – a negotiated and signed agreement in which partners commit to implement and uphold the priorities outlined in the national health strategy. Some of the main determining features of the IHP+ are the leadership of the recipient government over the preparation and implementation process of the Compact, broad domestic ownership of the national health plan, and mutual accountability for results. Methods: In this communication, we perform a comparative analysis of two very different approaches that have been followed in Mali and Benin. It is based on authors' experience in the IHP+ process in Mali, extensive document review and interviews with most significant stakeholders involved in the process both in Mali and Benin. Results: Mali has prepared its country Compact on the grounds of its 10-year experience in leading a sector-wide approach (SWAp) in the health sector. It has therefore benefited from improved donor coordination, MoH leadership in piloting the national programme, trust capital between partners and broad ownership of the health plan. It has succeeded in making the IHP+ process even more inclusive. On the contrary, Benin had no health SWAp to start with. The preparation process of the Compact was much less inclusive and country-led, resulting in narrow ownership and vague commitments. Nevertheless, it is hoped that the IHP+ can help launch a new partnership dynamic within the health sector. Conclusion: Beyond common principles, the IHP+ is put into practice in different ways from country to country according to their context. [less ▲]

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See detailCan performance-based financing be used to reform health systems in developing countries?
Ireland, Megan; Paul, Elisabeth ULiege; Dujardin, Bruno

in Bulletin of the World Health Organization (2011), 89(9), 695-698

Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling ... [more ▼]

Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. We resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. We also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package. [less ▲]

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See detailL'appui budgétaire est-il une solution pour le financement du secteur de la santé dans les pays en développement?
Paul, Elisabeth ULiege

Scientific conference (2011, May)

L'aide au développement dans le secteur de la santé est extrêmement fragmentée, ce qui risque d’en diminuer l’efficacité (WHO 2007, Piva & Dodd 2009). L'appui budgétaire (AB) est souvent présenté comme un ... [more ▼]

L'aide au développement dans le secteur de la santé est extrêmement fragmentée, ce qui risque d’en diminuer l’efficacité (WHO 2007, Piva & Dodd 2009). L'appui budgétaire (AB) est souvent présenté comme un instrument de financement permettant d’améliorer l'efficacité de l'aide en respectant les principes énoncés dans la Déclaration de Paris. Si ceci est probablement vrai en théorie lorsque les conditions le permettent, il est très difficile d'évaluer l'impact de l’AB, vu les problèmes d’attribution que cela suppose. Des évaluations de l'AB général ont été réalisées dans plusieurs pays, mais qui n’ont pas étudié spécifiquement ses effets sur le secteur de la santé. La communication a pour objectif de faire le point des connaissances sur les effets de l'AB sur le secteur de la santé, et de discuter deux aspects qui n'ont guère fait l’objet d’études et qui pourtant sont des défis importants pour l'efficacité de l'AB dans le secteur: d'une part, les défis de gestion que l'AB pose aux ministères de la santé concernés et d'autre part, les avantages et inconvénients respectifs de l'AB général et sectoriel pour le secteur de la santé. Dans la première partie de la communication, nous présentons brièvement les résultats des principales évaluations de l'AB disponibles à ce jour, qui toutes se sont penchées sur l'AB général, mais dont certaines ont quelque peu traité du secteur de la santé (IDD and Associates 2006, Koeberle et al. 2006, Lawson et al. 2006, DfID 2008, European Court of Auditors 2008, OXFAM 2008, Beynon & Dusu 2010). Nous évoquons également une étude commissionnée par l'OMS qui a tenté de démontrer les liens entre l'AB général et les dépenses de santé (Fernandes Antunes et al. 2010). Dans la seconde partie de l'exposé, nous attirons l'attention des participants sur les implications pratiques de la gestion de l’AB pour les ministères de la santé des pays récipiendaires. Très peu a été écrit sur le sujet, mais nous nous baserons sur notre expérience d'assistante technique en appui à la gestion de l'AB au Ministère de la Santé du Mali pour dégager quelques leçons (Samaké et al. 2009). Ensuite, partant du fait qu'il n'existe une fois de plus quasiment pas de littérature sur les effets spécifiques de l'AB sectoriel en comparaison avec l'AB général, nous discutons des avantages et inconvénients perçus par les acteurs relatifs à ces deux modalités. Nous concluons en dégageant quelques leçons générales et en soulignant le fait que, bien qu'on en parle beaucoup, l'AB n'est pas encore très significatif dans le secteur de la santé comparé à la multiplication des interventions spécifiques (Ravishankar et al. 2009, Fernandes Antunes et al. 2010). Dès lors, des recherches bien ciblées sur ses effets pour le secteur de la santé sont bienvenues afin de documenter s’il s'agit ou non d'une modalité d'aide efficace qui devrait être encouragée. [less ▲]

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