Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Abstract

Supported by the World Bank (WB), Chad implemented a performance-based financing (PBF) scheme as a pilot, from October 2011 to May 2013. However, despite promising results and the government's stated commitment to ensure its continuation after the World Bank's departure, PBF failed to come onto the national policy agenda. This article aims to explain why this was the case, an especially interesting question given that several factors were favorable for project continuation. Data for this case study were collected through literature review and key informant interviews. We applied Kingdon's agenda setting theory to explain this failure. We found that though the potential of PBF to address challenges facing the Chadian health system was confirmed by internal and external evaluations of the pilot, it failed to move from the governmental agenda to the decision agenda. The main reason was a lack of dedicated policy entrepreneurs, resulting in a weak actual ownership of the policy by national authorities and key stakeholders. We tried to understand why such policy entrepreneurs failed to emerge.

Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study

“…Matland suggests that, in this type of implementation, “remunerative mechanisms will predominate,” 46(p163) which appears to be the case here. Performance‐based financing has been implemented primarily because the World Bank wants it and has very sizeable funds that are difficult to refuse in the national context—which was nevertheless done, for example, in Chad—and a coalition of international and national actors was created to help disseminate it.…”

From Scheme to System (Part 1): Notes on Conceptual and Methodological Innovations in the Multicountry Research Program on Scaling Up Results-Based Financing in Health Systems

“…The articles by Kiendrebeogo et al and Sieleunou et al in this special issue address the country-specific research questions. 5,11 To identify enablers and barriers to proceeding through the phases of scale-up, the country teams were guided to use the elements of the Walt and Gilson health policy analysis framework: actors, context, content, and process. 6 A common, yet adaptable, template for the case study design was reviewed and adopted during a protocol development workshop with the country research teams.…”

“…39 Several country teams complemented this framework with political science theories or alternative frameworks to answer their specific research questions, as exemplified by the case studies in this special issue from Cameroon 11 and Chad. 5 Third, the four-phase model of scale-up proved useful but still requires additional scientific validation. Such a sequential approach has also been proposed by researchers working on social innovation in high-income countries.…”

“…Some recent experiences indicate that moving beyond pilot projects is not straightforward, as described in the Chad country case study in this issue. 5 National policy makers and aid agencies involved in RBF look for practical guidance. However, most assessments of RBF thus far have been limited to impact evaluation of pilot programs.…”

National Scale-Up of Results-Based Financing in Primary Health Care: The Case of Armenia

“…[18][19][20] However, the Ministry of Health, through its State Health Agency, was centrally involved, including through the provision of resources right from the beginning of the pilot, something that sets Armenia apart from the other three country studies in this series (Cameroon, Cambodia, and Chad) where initial pilots were largely donor funded. [29][30][31] The importance of the USAID and the SHA working together was underscored by the following quote: "The program [scaling up] was mainly performed by the State Health Agency and Ministry of Health. Mainly it was implemented by the SHA .…”