The bumpy trajectory of performance-based financing for healthcare in Sierra Leone

ReBUILD partner, the Queen Margaret University Institute for Global Health and Development (IGHD), published a paper on performance-based financing (PBF).

‘The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process‘ looks at the political economy of PBF in Sierra Leone and is part of research the IGHD team is carrying out with ReBUILD on PBF in fragile settings.

NB This case study featured in a presentation given by Maria Bertone at the Fifth Global Symposium on Health Systems Research in October 2018. Watch it here.

Background

As PBF has been increasingly implemented in low-income countries, a growing literature has developed, assessing its effectiveness and, more recently, focusing on the political dynamics of PBF introduction and implementation. This study contributes to the latter body of literature by exploring decision-making processes on PBF in Sierra Leone during the 2010–2017 period. Sierra Leone presents an interesting case because of the ‘start-stop-start’ trajectory of PBF.

Findings

The paper highlights the role of different players, both internal and external, their ideas, capacity and power relations, and the shifting narratives around PBF. It shows that external actors driving the debate make use of ‘frames’, botactual (ie defining the timing and pace of the discussions, the funding available, etc.) and metaphorical (ie, how PBF is interpreted, defined and understood) to fit in and influence the debate. This is facilitated by the lack of capacity and resources in the fragile setting. Other strategies, such as ‘venue shopping’ are employed, though they may add to fragmentation in the volatile context.

Accessing the paper

You can download this Globalization and Health paper here.

References

Maria Paola Bertone¹, Haja Wurie², Samai M² and Witter S¹. The bumpy trajectory of performance-based financing for healthcare in Sierra Leone: agency, structure and frames shaping the policy process (Globalization and Health (2018) 14:99 https://doi.org/10.1186/s12992-018-0417-y)

1 ReBUILD & Institute for Global Health and Development (IGHD), Queen Margaret University, Edinburgh, UK.
2 ReBUILD & College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone.