Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems
Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), bu...
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description | Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. Another area meriting more study is the political economy of PBF and its diffusion across contexts. |
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A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Bertone, Maria Paola ; Falisse, Jean-Benoît ; Russo, Giuliano ; Witter, Sophie</creator><contributor>Yao, Nengliang (Aaron)</contributor><creatorcontrib>Bertone, Maria Paola ; Falisse, Jean-Benoît ; Russo, Giuliano ; Witter, Sophie ; Yao, Nengliang (Aaron)</creatorcontrib><description>Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. 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A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). 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A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-04-03</date><risdate>2018</risdate><volume>13</volume><issue>4</issue><spage>e0195301</spage><epage>e0195301</epage><pages>e0195301-e0195301</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. 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subjects | Adaptation Adaptations Domestic economic assistance Economic aspects Financing Fragility Global health Health Facilities - economics Health services Healthcare Financing Humans Hypotheses Influence Literature reviews Maternal & child health Medical research Medicine and Health Sciences Methods People and Places Public health Public health administration Public policy Reimbursement, Incentive Relief Work - economics Social Problems Social Sciences |
title | Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems |
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