Publications des membres du Ceped


  • Gallardo Lucille, Gautier Lara, Chabrol Fanny, Traverson Lola, Oliveira Sydia et Ridde Valery (2023) Les cabinets de conseil privés dans l'action publique contre les épidémies : une revue exploratoire (139), Sciences Po - LIEPP.
    Résumé : Si la recherche en sciences sociales sur le rôle des cabinets de conseil privés dans l’action publique est foisonnante, leur intervention dans la gestion publique de crises sanitaires ou d’épidémies est peu étudiée. La pandémie de COVID-19 a pourtant révélé un recours important à ces firmes de la part d’administrations publiques de nombreux pays. Cette revue exploratoire des écrits scientifiques a pour objectif d’identifier les recherches qui portent sur la participation de ces cabinets au gouvernement d’épidémies et de crises sanitaires survenues depuis 2000 : que disent-elles du rôle de ces cabinets et quelles méthodes sont mobilisées ? Les étapes du modèle PRISMA-ScR ont permis d’identifier seulement 24 références depuis 2000. Trois approches sont mobilisées par les auteur·e·s qui déterminent leur analyses sur le rôle des cabinets : l’approche gestionnaire, la consultocratie et l’hybridation des élites. Cette revue permet de rendre compte d’un point aveugle des écrits scientifiques et appelle à la réalisation de recherches empiriques sur le sujet.

  • Gautier Lara, Noda Shinichiro, Chabrol Fanny, David Pierre-Marie, Duhoux Arnaud, Hou Renyou, Rosana de Araújo Oliveira Sydia, Traverson Lola, Zinszer Kate et Ridde Valéry (2023) « Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study », Health Systems & Reform, 9 (2) (juin 15), p. 2173551. DOI : 10.1080/23288604.2023.2173551.
    Résumé : In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals’ governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital’s diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals’ environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.
    Mots-clés : Comparative health systems, hospital governance, multiple case study, resilience.

  • Richard Zoé, Chabrol Fanny, Gautier Lara, Zinszer Kate et Ridde Valéry (2023) « Considering social inequalities in health in COVID-19 response: insights from a French case study », Health Promotion International, 38 (1) (février 1), p. daac173. DOI : 10.1093/heapro/daac173.
    Résumé : The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.The COVID-19 pandemic has highlighted the importance of social inequalities in health (SIH) and the disproportionate burden of the pandemic and its consequences related to socioeconomic status, ethnicity and race, among other determinants of health. Public health interventions are likely to increase SIH when they are not considered in the design phase. Through a qualitative case study, we analyzed the design of one of the first local initiative providing testing and contact tracing offer to the general population in the Île-de-France region (Paris region, France) in response to the COVID-19 pandemic. This article discusses the uncertainty and challenges associated with consideration for SIH in the intervention design. It explores the diverse understandings of SIH among the actors and the complexities of cross-sectoral partnerships addressing SIH in times of health crisis. Despite a consensual concern for this issue among the respondents, an epidemiological frame of reference dominated the intervention design. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission.

  • Ridde Valery, Coulibaly Abdourahmane et Gautier Lara (2023) « Case studies », LIEPP Methods Brief / Fiches méthodologiques du LIEPP (mai 12).
    Résumé : Case studies consist of an in-depth analysis of one or more cases, using a variety of methods and theoretical approaches. The choice of cases (single or multiple) studied is crucial. Case studies are particularly suitable for studying the emergence and processes involved in policy implementation and for contributing to theory-based evaluations.
    Pièce jointe Full Text PDF 359.6 ko (source)

  • Ridde Valéry, Coulibaly Abdourahmane et Gautier Lara (2023) « Les études de cas », LIEPP Methods Brief / Fiches méthodologiques du LIEPP (mai 11).
    Résumé : Les études de cas consistent à analyser de façon approfondie un ou plusieurs cas, à partir d’une diversité de méthodes et au regard d’approches théoriques. Le choix des cas (unique ou multiples) étudiés est crucial. Les études de cas sont particulièrement adaptées pour étudier l’émergence et les processus en jeu dans la mise en œuvre des politiques et pour participer aux évaluations basées sur la théorie.
    Pièce jointe Full Text PDF 458.5 ko (source)


  • Boivin Pauline, Gautier Lara, Coulibaly Abdourahmane, Zinszer Kate et Ridde Valéry (2022) « Exploring how social inequalities in health have influenced the design of Mali’s SARS-CoV-2 testing policy: a qualitative study », Health Policy and Planning (novembre 18), p. czac097. DOI : 10.1093/heapol/czac097.
    Résumé : Abstract In the fight against infectious diseases, social inequalities in health (SIH) are generally forgotten. Mali, already weakened by security and political unrest, has not been spared by the COVID-19 pandemic. Although the country was unprepared, the authorities were quick to implement public health measures, including a SARS-CoV-2 testing programme. This study aimed to understand if and how social inequalities in health were addressed in the design and planning for the national COVID-19 testing policy in Mali. A qualitative survey was conducted between March and April 2021 in Bamako, the capital of Mali. A total of 26 interviews were conducted with key government actors and national and international partners. A document review of national reports and policy documents complemented this data collection. The results demonstrated that the concept of SIH was unclear to the participants and was not a priority. The authorities focused on a symptom-based testing strategy that was publicly available. Participants also mentioned some efforts to reduce inequalities across geographical territories. The reflection and consideration of SIH within COVID-19 interventions was difficult given the governance approach to response efforts. The urgency of the situation, the perceptions of COVID-19 and the country’s pre-existing fragility were factors limiting this reflection. Over time, little action has been taken to adapt to the specific needs of certain groups in the Malian population. This study (re)highlights the need to consider SIH in the planning stages of a public health intervention, to adapt its implementation and to limit the negative impact on SIH.

  • Gagnon-Dufresne Marie-Catherine, Gautier Lara, Beaujoin Camille, Lamothe Ashley Savard, Mikanagu Rachel, Cloos Patrick, Ridde Valéry et Zinszer Kate (2022) « Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study », BMC Public Health, 22 (1), p. 749. DOI : 10.1186/s12889-022-13163-3.
    Résumé : Abstract Background Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). Methods Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. Results Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. Conclusions These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.

  • Gallardo Lucille, Gautier Lara, Chabrol Fanny, Traverson Lola, Oliveira Sydia et Ridde Valery (2022) « Consulting firms in the public management of epidemics. A scoping-review protocol », DOI : 10.17504/
    Résumé : The aim of this scoping review is to produce a state of knowledge about the role of private consulting firms in the public management of epidemics. The review will also identify...
    Mots-clés : ⛔ No DOI found.

  • Gautier Lara, Borgès Da Silva Roxane, Faye Adama et Ridde Valéry (2022) « Patient‐ and community‐centered approaches as the cornerstone of health services evaluation in the 21st century », The International Journal of Health Planning and Management, 37 (S1), p. 4-7. DOI : 10.1002/hpm.3568.

  • Gautier Lara, Nguengang Wakap Stéphanie, Verrier Florian, da Silva Miranda Érica, Négré Victoria, Hamza Jalel, Poveda Juan-Diego et Bouchon Magali (2022) « Responding to Increasing Health and Social Needs of Unprotected Unaccompanied Minors in Paris in the Context of COVID-19: A Mixed Methods Case Study », Journal of Immigrant & Refugee Studies (janvier 19), p. 1-20. DOI : 10.1080/15562948.2022.2027057.
    Résumé : Unaccompanied minors (UMs) are children under the age of 18 who settle in a foreign country without a legal representative. In France, many UMs are left unprotected from child welfare services because assessment systems evaluate that they are not minors. In Paris, the non-governmental organization Médecins du Monde (MdM) offers unprotected UMs medical, psychological, and social care. In March 2020, the lockdown policy to contain COVID-19 constrained MdM to adapt its care provision model. This case study sought to answer the following question: how did volunteers and employees of MdM respond to the social and health needs of unprotected UMs during the spring 2020 lockdown in Paris? We analyzed a cohort of 58 UMs for eight weeks of lockdown using secondary quantitative data. We further explored the UMs’ needs and the experience of phone consultations, through 15 interviews with MdM’s program volunteers and employees. Time series showed a steady increase in UMs’ needs. The program’s adapted care provision likely contributed to reducing UMs’ feeling of isolation. It also had several negative consequences for unprotected UMs, volunteers, employees, and Médecins du Monde’s institution. This study highlights the role of non-governmental organizations in providing a particularly vulnerable migrant population – unprotected UMs – care and support, despite operational challenges in crisis times.
    Mots-clés : care provision, COVID-19 pandemic, France, mixed methods study, Unaccompanied Minors.

  • Jessani Nasreen S., Williamson R. Taylor, Choonara Shakira, Gautier Lara, Hoe Connie, Jafar Sakeena K., Khalid Ahmad Firas, Rodríguez Salas Irene, Turcotte-Tremblay Anne-Marie et Rodríguez Daniela C. (2022) « Evidence attack in public health: Diverse actors’ experiences with translating controversial or misrepresented evidence in health policy and systems research », Global Public Health (janvier 7), p. 1-17. DOI : 10.1080/17441692.2021.2020319.
    Résumé : Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.
    Mots-clés : censorship, controversy, Evidence-informed decision-making, health policy and systems research, infodemic, knowledge translation, misinformation.

  • Niang Marietou, Moha Mahaman, Ridde Valéry et Gautier Lara (2022) « La pérennité d’un projet de prévention et de prise en charge de la malnutrition au Niger », Canadian Journal of Public Health (avril 18). DOI : 10.17269/s41997-022-00631-x.


  • Clavel Nathalie, Badr Janine, Gautier Lara, Lavoie-Tremblay Mélanie et Paquette Jesseca (2021) « Risk Perceptions, Knowledge and Behaviors of General and High-Risk Adult Populations Towards COVID-19: A Systematic Scoping Review », Public Health Reviews, 42, p. 1-22. DOI : 10.3389/phrs.2021.1603979.
    Résumé : The COVID-19 pandemic represents a major crisis for governments and populations. The public’s risk perceptions, knowledge, and behaviors are key factors that play a vital role in the transmission of infectious diseases. Our scoping review aims to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID-19. A systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of COVID-19. Thirty-one studies meeting the inclusion criteria were appraised and analyzed.The levels of risk perceptions, knowledge, and behaviors towards COVID-19 were moderate to high in both general and high-risk adult populations. The perceived severity of the disease was slightly higher than the perceived susceptibility of getting COVID-19. Adults were knowledgeable about preventive behaviors. Nevertheless, an important knowledge gap regarding the asymptomatic transmission of COVID-19 was reported in many studies. Our review identified hand-washing and avoiding crowded places as dominant preventive behaviors. Being a female, older, more educated, and living in urban areas was associated with better knowledge of COVID-19 and appropriate preventive behaviors.

  • Fillol Amandine, Gautier Lara et Ridde Valéry (2021) « L’avènement de la couverture sanitaire universelle dans la gouvernance globale: », Revue internationale des études du développement, 247 (3) (novembre 10), p. 139-172. DOI : 10.3917/ried.247.0139.

  • Gautier Lara (2021) « From development brokers to diffusion entrepreneurs: a review of concepts designating influential policy actors in global governance », in POLICY DIFFUSION: NEW CONSTRAINTS, NEW REALITIES. Proceedings of the II International Conference on Policy Diffusion and Development Cooperation, par Osmany Porto de Oliveira, Sao Paulo : Balão Editorial, p. 81-102.
    Résumé : Policy ideas travel through space and time thanks to people and communities who give them meaning. Public policy analysts, development anthropologists and others, have conceived a wide array of terminologies to designate those influential policy actors who actively participate in the ‘traveling’ of those policy ideas. In this chapter, we adopt the ideational perspective of policy analysis to review the public policy and social science literatures. We offer a comprehensive overview of the terminologies used and applied in the context of global policymaking. We review each concept through a critical eye, highlighting some of their strengths and limitations, particularly in the constantly evolving context of ‘multi-centric’ governance. We draw on the limitations of each reviewed concept to suggest another concept, that would incorporate the multi-centric nature of contemporary global governance - that of 'diffusion entrepreneurs'. Questions can be raised as to the opportunity and relevance of adding yet another concept to describe policy actors in global governance. We attempt to answer these questions in the second part of the chapter. We close this conceptual review by sharing reflections on the future of applying the global policy entrepreneurs/ agents/ translators/ brokers terminologies from a decolonial angle.

  • Gautier Lara, Poveda Juan-Diego, Nguengang Wakap Stéphanie, Bouchon Magali et Quesnel-Vallée Amélie (2021) « Adapting care provision and advocating for unprotected unaccompanied minors in Paris in the context of COVID-19 », Global Health Promotion (janvier 13), p. 175797592098419. DOI : 10.1177/1757975920984193.
    Résumé : Unaccompanied minors (UMs) are children under 18 who arrive on the territory of a foreign country without the care of a guardian. In many countries their access to social and health care services depends on their legal recognition as minors. For instance, in France, high rejection rates of minor status place unprotected UMs in social precarity, such that in Paris, civil society organizations (CSOs) have stepped in to offer social, medical, and psychological care to unprotected UMs. In the context of the COVID-19 pandemic however, CSOs had to adapt their care provision. We review promising CSO-led initiatives to ensure continuity of care for this population. In doing so, we highlight how, by promoting UMs’ healthy behaviors in the context of the pandemic, continued social interactions between CSO members and unprotected UMs may have contributed to disease prevention among UMs. In addition, CSOs have continued to advocate for sheltering unprotected UMs, calling on public authorities to take action.

  • Jones Catherine M, Gautier Lara et Ridde Valéry (2021) « A scoping review of theories and conceptual frameworks used to analyse health financing policy processes in sub-Saharan Africa », Health Policy and Planning (mai 24), p. czaa173. DOI : 10.1093/heapol/czaa173.
    Résumé : Health financing policies are critical policy instruments to achieve Universal Health Coverage, and they constitute a key area in policy analysis literature for the health policy and systems research (HPSR) field. Previous reviews have shown that analyses of policy change in low- and middle-income countries are under-theorised. This study aims to explore which theories and conceptual frameworks have been used in research on policy processes of health financing policy in sub-Saharan Africa and to identify challenges and lessons learned from their use. We conducted a scoping review of literature published in English and French between 2000 and 2017. We analysed 23 papers selected as studies of health financing policies in sub-Saharan African countries using policy process or health policy-related theory or conceptual framework ex ante. Theories and frameworks used alone were from political science (35%), economics (9%) and HPSR field (17%). Thirty-five per cent of authors adopted a ‘do-it-yourself’ (bricolage) approach combining theories and frameworks from within political science or between political science and HPSR. Kingdon’s multiple streams theory (22%), Grindle and Thomas’ arenas of conflict (26%) and Walt and Gilson’s policy triangle (30%) were the most used. Authors select theories for their empirical relevance, methodological rational (e.g. comparison), availability of examples in literature, accessibility and consensus. Authors cite few operational and analytical challenges in using theory. The hybridisation, diversification and expansion of mid-range policy theories and conceptual frameworks used deductively in health financing policy reform research are issues for HPSR to consider. We make three recommendations for researchers in the HPSR field. Future research on health financing policy change processes in sub-Saharan Africa should include reflection on learning and challenges for using policy theories and frameworks in the context of HPSR.

  • Ridde Valéry, Gautier Lara, Dagenais Christian, Chabrol Fanny, Hou Renyou, Bonnet Emmanuel, David Pierre-Marie, Cloos Patrick, Duhoux Arnaud, Lucet Jean-Christophe, Traverson Lola, de Araujo Oliveira Sydia Rosana, Cazarin Gisele, Peiffer-Smadja Nathan, Touré Laurence, Coulibaly Abdourahmane, Honda Ayako, Noda Shinichiro, Tamura Toyomitsu, Baba Hiroko, Kodoi Haruka et Zinszer Kate (2021) « Learning from public health and hospital resilience to the SARS-CoV-2 pandemic: protocol for a multiple case study (Brazil, Canada, China, France, Japan, and Mali) », Health Research Policy and Systems, 19 (1) (mai 6), p. 76. DOI : 10/gjwdb7.
    Résumé : All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems.


  • Coulibaly Abdourahmane, Gautier Lara, Zitti Tony et Ridde Valéry (2020) « Implementing performance-based financing in peripheral health centres in Mali: what can we learn from it? », Health Research Policy and Systems, 18 (1). DOI : 10.1186/s12961-020-00566-0.
    Résumé : IntroductionNumerous sub-Saharan African countries have experimented with performance-based financing (PBF) with the goal of improving health system performance. To date, few articles have examined the implementation of this type of complex intervention in Francophone West Africa. This qualitative research aims to understand the process of implementing a PBF pilot project in Mali's Koulikoro region.MethodWe conducted a contrasted multiple case study of performance in 12 community health centres in three districts. We collected 161 semi-structured interviews, 69 informal interviews and 96 non-participant observation sessions. Data collection and analysis were guided by the Consolidated Framework for Implementation Research adapted to the research topic and local context.ResultsOur analysis revealed that the internal context of the PBF implementation played a key role in the process. High-performing centres exercised leadership and commitment more strongly than low-performing ones. These two characteristics were associated with taking initiatives to promote PBF implementation and strengthening team spirit. Information regarding the intervention was best appropriated by qualified health professionals. However, the limited duration of the implementation did not allow for the emergence of networks or champions. The enthusiasm initially generated by PBF quickly dissipated, mainly due to delays in the implementation schedule and the payment modalities.ConclusionPBF is a complex intervention in which many actors intervene in diverse contexts. The initial level of performance and the internal and external contexts of primary healthcare facilities influence the implementation of PBF. Future work in this area would benefit from an interdisciplinary approach combining public health and anthropology to better understand such an intervention. The deductive-inductive approach must be the stepping-stone of such a methodological approach.

  • Fillol Amandine, Kadio Kadidiatou et Gautier Lara (2020) « L’utilisation des connaissances pour informer des politiques publiques : d’une prescription technocratique internationale à la réalité politique des terrains », Revue francaise des affaires sociales, 4, p. 103-127. DOI : 10.3917/rfas.204.0103.
    Résumé : Le fait d’utiliser des connaissances explicites pour informer les décisions politiques est de plus en plus encouragé au niveau international, notamment par le mouvement d’information des politiques par les données probantes (evidence-informed policy making). Si la valeur sous-jacente à ce mouvement est de rationaliser le processus politique, les recherches en sciences sociales ont depuis longtemps permis d’observer que les connaissances sont des objets sociaux, dépendants des contextes politiques et économiques. L’objectif de notre analyse est de décrire à partir de trois études de cas (les politiques de protection sociale au Burkina Faso, une stratégie de transfert de connaissances sur les politiques de gratuité au Niger et la diffusion du financement basé sur la performance au Mali), comment ces connaissances, peuvent orienter la formulation des politiques publiques. Ces trois études de cas nous permettent d’observer que nous sommes loin des connaissances explicites comme vectrices de neutralité, de transparence et de reddition des comptes. Alors que la santé et la protection sociale sont des sujets prenant de plus en plus d’importance sur la scène globale, nous observons que l’utilisation des connaissances scientifiques ou de l’expertise est sensible aux intérêts, orientée par les institutions, et influencée par la mondialisation.

  • Fresneau Jérôme et Gautier Lara (2020) « À la croisée des chemins : le jeune chercheur entre désir d’interdisciplinarité et ancrage monodisciplinaire », Encyclo. Revue de l'école doctorale Science des sociétés (ED 624), 11 (juillet 22), p. 9-15.

  • Gautier Lara, Casseus Thierry, Blanc Judite et Cloos Patrick (2020) « What links can be made from narratives of migration and self-perceived health? A qualitative study with Haitian migrants settling in Quebec after the 2010 Haiti earthquake », Journal of Migration and Health, 1-2 (décembre 15), p. 100017. DOI : 10.1016/j.jmh.2020.100017.
    Résumé : In January 2010, Haiti was hit by a terrible earthquake that pushed thousands of people to migrate. Many of them chose to settle in Quebec, Canada. Years after the earthquake, many Haitians continue to migrate to the Quebec province. Several studies however have shown that this population's socioeconomic status is lower than the provincial average. Given the potential multiple stressors that affect Haitian migrants in Quebec, there are concerns about their health status. Located at the intersection of international migration studies and global public health, this paper offers an in-depth qualitative investigation of Haitian migrants’ representations of both their situation and self-perceived health in Montreal, Quebec. Our perspective on migrant health was inspired by the World Health Organisation's framework on the social determinants of health and recent studies in the field of migrant health. We collected and analysed qualitative data from 23 key informants (i.e., 12 women and 11 men, aged 21–76 years old) from diverse socioeconomic backgrounds. The analysis of the data from these people's narratives revealed the importance of structural determinants such as social position, and intermediate determinants such as living and working conditions. Our analysis also highlighted several interrelations between those determinants. Specifically, participants reported coping with issues related to migration status, income, occupation, language, challenging living and working conditions, and chronic stress. This study also shows that racism and social support each relate to both the structural and intermediate levels of the social determinants of health. The importance of social support brought by relatives, friends, as well as community-based organisations and religious practice, was underscored. Our findings were coherent with available literature looking at the determinants of health of racialized and migrant minorities in other high-income regions of the world. Our conclusive remarks featured reflections on three cross-cutting issues and their practical implications for policy and practices.
    Mots-clés : Canada, Earthquake, Haiti, Migrant health, Montreal, Qualitative research, Quebec, Racism, Social determinants of health.

  • Gautier Lara et Confortini Catia C (2020) « How to teach global public health during a pandemic », University Affairs.
    Résumé : Here is our learning-by-doing experience of teaching online courses about the COVID-19 response.

  • Gautier Lara, De Allegri Manuela et Ridde Valéry (2020) « Transnational Networks’ Contribution to Health Policy Diffusion: A Mixed Method Study of the PerformanceBased Financing Community of Practice in Africa », International Journal of Health Policy and Management (avril 27). DOI : 10.34172/ijhpm.2020.57.
    Résumé : Background: Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA). Methods: Informed by the diffusion entrepreneurs’ (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP’s online discussion forum (n=1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n=40) and data extracted from the CoP’s key documentation (n=17). Results: CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time. Conclusion: This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF. Keywords: Transnational Policy Networks, Communities of Practice, Social Network Analysis, Semantic Analysis, Performance-Based Financing, Sub-Saharan Africa

  • Gautier Lara, Karambé Youssouf, Dossou Jean-Paul et Samb Oumar Mallé (2020) « Rethinking development interventions through the lens of decoloniality in sub-Saharan Africa: The case of global health », Global Public Health (décembre 8), p. 1-14. DOI : 10.1080/17441692.2020.1858134.
    Résumé : There has been much talk about decolonizing global health lately. The movement, which has arisen in various communities around the world, suggests an interesting critique of the Western dominant model of representations. Building upon the ‘decolonial thinking’ movement from the perspective of Francophone African philosophers, we comment on its potential for inspiring the field of global healthinterventions. Using existing literature and personal reflections, we reflect on two widely known illustrations of global health interventions implemented in sub-Saharan Africa – distribution of contraceptives and dissemination of Ebola virus prevention and treatment devices – featuring different temporal backdrops. We show how these solutions have most often targeted the superficial dimensions of global health problems, sidestepping the structures and mental models that shape the actions and reactions of African populations. Lastly, we question the ways through which the decolonial approach might indeed offer a credible positioning for rethinking global health interventions.
    Mots-clés : decoloniality, development interventions, Global health, sub-Saharan Africa.

  • Gautier Lara et Quesnel-Vallée A. (2020) « Health and social needs of unprotected unaccompanied minors in Paris in the context of COVID-19 », European Journal of Public Health, 30 (Supplement_5) (septembre 1). DOI : 10.1093/eurpub/ckaa166.296.
    Résumé : Background Unaccompanied minors (UMs) are children under 18 settling in foreign countries without the care of a guardian. Host countries' governments are responsible for the care of UMs. In France, UMs theoretically receive child protection. However, assessment systems frequently deny their protection because of minority status rejection. As a result, they navigate through social precarity and have limited access to healthcare services. In Paris, the non-governmental organisation Médecins du Monde (MdM) offers them medico-psycho-social care. In March 2020, lockdown measures to contain COVID-19 further reduced unprotected UMs' access to social and healthcare services. This critical situation prompted MdM to adapt their care provision to the pandemic. In this research, we sought answers to the following research question: what were unprotected UMs' social and healthcare needs during lockdown and what was MdM's response? Methods First, we estimate the evolution of social and healthcare needs of a cohort of 58 unprotected UMs during the eight-week lockdown using secondary data. Second, using interview data with MdM volunteers and staff (n = 15) we further explore UMs' needs and document the experience of phone consultations with this cohort of UMs. Preliminary Results Time series show a constant increase of UMs' needs through time. MdM's new form of care provision may have contributed to alleviate their feeling of isolation. It also had unintended consequences. Conclusions In light of the alarming healthcare status of unprotected UMs, we recommend that France implements the public health authorities' recommendation to provide appropriate shelter to UMs regardless of their status, at least during health crises.

  • Gautier Lara et Samb Oumar Mallé (2020) « Pourquoi et comment faire du terrain? », in Guide décolonisé et pluriversel de formation à la recherche en sciences sociales et humaines, Québec, Canada : Éditions science et bien commun.
    Résumé : Dans ce chapitre, vous trouverez des réponses aux questions suivantes : Pour quelles raisons serait-il pertinent de se rendre sur le terrain ? Comment créer les conditions de « confort » vis-à-vis de son terrain de recherche ? La première question évoque le rapport de la ou du chercheur aux sciences sociales, tandis que la seconde se rapporte au degré de légitimité et d’implication de la ou du chercheur vis-à-vis de son objet d’étude.

  • Gautier Lara, Spagnolo Jessica et Quesnel-Vallée Amélie (2020) « Comment favoriser la communication thérapeutique avec une population vulnérable ?: Des approches et des outils pour les professionnels prenant en charge les mineurs non accompagnés », Migrations Société, N°181 (3), p. 121. DOI : 10.3917/migra.181.0121.
    Résumé : En France, les mineurs non accompagnés (mna) rencontrent de multiples obstacles qui peuvent avoir des effets négatifs sur leur santé mentale. Les professionnels de la santé et du social qui participent à leur prise en charge doivent développer et mettre en œuvre des approches et outils adaptés aux réalités des mna et qui leur offrent un espace d’interactions le plus ouvert possible. À partir d’une revue de littérature, nous proposons dans cet article de dresser un état des lieux de la santé mentale des mna et d’identifier les approches ainsi que les outils développés et mis en œuvre par les professionnels qui visent à favoriser la communication et l’expression des mna (notamment l’approche interculturelle, le travail en interdisciplinarité, l’art-thérapie). Nous formulons en conclusion plusieurs pistes de réflexion à l’endroit des professionnels et des pouvoirs publics qui travaillent avec ce jeune public migrant.

  • Spagnolo Jessica, Gautier Lara, Champagne François, Leduc Nicole, Melki Wahid, N’Guessan Konan et Charfi Fatma (2020) « Reflecting on knowledge translation strategies from global health research projects in Tunisia and the Republic of Côte d’Ivoire », International Journal of Public Health (octobre 17). DOI : 10.1007/s00038-020-01502-3.
    Résumé : We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake.

  • Spagnolo Jessica, Gautier Lara, Seppey Mathieu et D’souza Nicole Anne (2020) « Re-thinking global and public health projects during the COVID-19 pandemic context: Considerations and recommendations for early- and not-so-early-career researchers », Social Sciences & Humanities Open, 2 (1), p. 100075. DOI : 10.1016/j.ssaho.2020.100075.
    Résumé : This commentary aims to provide a glimpse into some of the early and continuing impacts of the COVID-19 pandemic on our global and public health projects: research in low-resourced settings; research with vulnerable populations, such as asylum seekers, Indigenous communities, children, and mental health service users; and research with healthcare professionals, frontline workers, and health planners. In the early context of restrictions caused by COVID-19, this commentary highlights our research setbacks and challenges, and the ways in which we are adapting research methodologies, while considering ethical implications related to the pandemic and their impacts on conducting global and public health research. As we learn to become increasingly aware of some of our limitations in the face of the pandemic, some positives are also worth highlighting: we are mobilizing our training and research skills to participate in COVID-19 projects and to disseminate knowledge on COVID-19, including through papers such as this one. However, we do acknowledge that these opportunities have not been equitable. Each thematic section of this commentary concludes with key recommendations related to research in the early and continuing context of the COVID-19 pandemic that we believe to be applicable to early- and not-so-early-career researchers working in the global and public health fields. Previous article in issueNext article in issue Keywords COVID-19ResearchersGlobal healthPublic health


  • Chabrol Fanny, Fillol Amandine et Gautier Lara (2019) Comment mobiliser la recherche pour la couverture sanitaire universelle ? Valorisation d ela Journée du 15 octobre 2018, Montréal : Cahiers Sientifiques Realisme-Recherches appliquées interventionnelles en santé et équité.
    Résumé : Le 15 octobre 2018, l’Agence Française de Développement (AFD) et le Centre Population et Développement (CEPED/IRD) ont organisé une journée de travail et de réflexion sur les enjeux de la mobilisation de la recherche en faveur de la couverture santé universelle dans le contexte francophone. Cette journée a réuni 40 participants francophones : chercheurs, décideurs, bailleurs de fonds, et intervenants en santé mondiale. La journée a commencé par un court cadrage théorique (Émilie Robert et Valéry Ridde) sur la science de la mobilisation de connaissances, suivi de six présentations de partage d’expériences concrètes de mobilisation de connaissances en faveur de la couverture de la santé universelle (Jean-Patrick Alfred, Dheepa Rajan, Marion Ravit, Khoudia Sow, Carine Baxerres, Graziella Ghesquière). La suite de la journée a été consacrée à des travaux de groupe. Trois thèmes ont été identifiés au préalable (la formation, les activités et les enjeux politiques), et les participants ont été invités à prendre part aux discussions de groupe en vue de procéder à un état des lieux et de formuler des propositions pour améliorer la mobilisation de la recherche. Ces trois sessions parallèles ont été suivies de restitutions en plénière afin d’enrichir le débat. Finalement, la journée s’est clôturée par une table ronde sur le rôle de la société et des médias avec deux invitées, Rahamata Diaouré et Sandra Lhote-Fernandes.

  • Coulibaly Abdourahmane, Gautier Lara, Touré Laurence et Ridde Valery (2019) « Le financement basé sur les résultats (FBR) au Mali : peut-on parler d’émergence d’une politique publique de santé ? », Revue internationale de politique de développement, 12 (1) (décembre 3). DOI : 10.4000/poldev.3242.
    Résumé : Le financement basé sur les résultats (FBR) compte parmi les expérimentations récentes mises en place au Mali pour améliorer les indicateurs de santé maternelle et infantile. À partir d’une analyse basée sur la théorie des courants de Kingdon (1984) et d’une approche inspirée de l’anthropologie du développement, l’article présente une étude qualitative qui vise à décrire les formes d’appropriation nationale du FBR et à comprendre si, à ce stade, on peut parler d’émergence d’une politique publique de FBR dans ce pays. L’apport de cette étude se situe au double plan théorique (comprendre l’émergence d’une politique) et empirique (rôles des acteurs locaux et des acteurs internationaux). Les données proviennent de 33 entrevues qualitatives réalisées auprès de personnes représentant diverses institutions, notamment le Ministère de la santé. Les résultats suggèrent une absence d’émergence d’une politique publique de FBR au Mali à cause d’une myriade de contraintes : peu d’entrepreneurs politiques, peu de fenêtres d’opportunités et de partenaires financiers intéressés ainsi que de trop courtes durées de mise en œuvre des projets pilotes.

  • Gautier Lara, Coulibaly Abdourahmane, De Allegri Manuela et Ridde Valéry (2019) « From Amsterdam to Bamako: a qualitative case study on diffusion entrepreneurs’ contribution to performance-based financing propagation in Mali », Health Policy and Planning (septembre 16), p. czz087. DOI : 10.1093/heapol/czz087.
    Résumé : For the past 15 years, several donors have promoted performance-based financing (PBF) in Africa for improving health services provision. European and African experts known as ‘diffusion entrepreneurs’ (DEs) assist with PBF pilot testing. In Mali, after participating in a first pilot PBF in 2012–13, the Ministry of Health and Public Hygiene included PBF in its national strategic plan. It piloted this strategy again in 2016–17. We investigated the interactions between foreign experts and domestic actors towards PBF diffusion in Mali from 2009 to 2018. Drawing on the framework on DEs (Gautier et al., 2018), we examine the characteristics of DEs acting at the global, continental and (sub)national levels; and their contribution to policy framing, emulation, experimentation and learning, across locations of PBF implementation. Using an interpretive approach, this longitudinal qualitative case study analyses data from observations (N = 5), interviews (N = 33) and policy documentation (N = 19). DEs framed PBF as the logical continuation of decentralization, contracting policies and existing policies. Policy emulation started with foreign DEs inspiring domestic actors’ interest, and succeeded thanks to longstanding relationships and work together. Learning was initiated by European DEs through training sessions and study tours outside Mali, and by African DEs transferring their passion and tacit knowledge to PBF implementers. However, the short-time frame and numerous implementation gaps of the PBF pilot project led to incomplete policy learning. Despite the many pitfalls of the region-wide pilot project, policy actors in Mali decided to pursue this policy in Mali. Future research should further investigate the making of successful African DEs by foreign DEs advocating for a given policy.

  • Gautier Lara, De Allegri Manuela et Ridde Valéry (2019) « How is the discourse of performance-based financing shaped at the global level? A poststructural analysis », Globalization and Health, 15 (1) (décembre). DOI : 10/gfth5f.
    Résumé : Background Performance-based financing (PBF) in low- and middle-income settings has diffused at an unusually rapid pace. While many studies have looked at PBF implementation processes and effects, there is an empirical research gap investigating the ways PBF has diffused. Discursive processes are paramount elements of policy diffusion because they explain the origins of essential elements of the political debate on PBF. Using Bacchi’s poststructural approach that emphasises problem representations embedded in the discourse, the present study analyses the construction of the global discourse on PBF. Methods A rich corpus of qualitative data (57 in-depth interviews and 10 observation notes) was collected. The transcribed material was coded using QDAMiner©. Codes were assembled to populate analytical categories informed by the framework on diffusion entrepeneurs and Bacchi’s poststructural approach. Results Our results feature problem representations shaped and spread by PBF global diffusion entrepreneurs. We explain how these representations reflected diffusion entrepreneurs’ own belief systems and interests, and conflicted with those of non-diffusion entrepreneurs. This research also reveals the specific strategies global diffusion entrepreneurs engaged in to effectively diffuse PBF, through reflecting problem representations based on the discourse on PBF, and inducing certain forms of policy experimentation, emulation, and learning. Conclusions Bacchi’s poststructural approach is useful to analyse the construction of global health problem representations and the strategies set by global diffusion entrepreneurs to spread these representations. Future research is needed to investigate the belief systems, motivations, resources, and strategies of actors that shape the construction of global health discourses.

  • Merry Lisa, Turcotte-Tremblay Anne-Marie, Alam Nazmul, D’souza Nicole, Fillion Myriam, Fregonese Federica, Gautier Lara et Kadio Kadidiatou (2019) « The Global Health Research Capacity Strengthening (GHR-CAPS) Program: trainees’ experiences and perspectives », Journal of Global Health Reports, 3 (décembre 28). DOI : 10.29392/joghr.3.e2019086.
    Résumé : # Introduction This paper aims to contribute to the discussion on how global health research (GHR) mentorship initiatives can best help prepare the next generation of GH researchers. To this end, the authors, a group of emerging researchers, share their experiences and perspectives of participating in the Global Health Research Capacity Strengthening (GHR-CAPS) program, a multidisciplinary GHR training and mentorship program in Quebec, Canada. # Discussion Based on their experiences, what is deemed most beneficial is interfacing with a diverse group of peers, learning and being guided from a community of mentors, actively engaging in research activities, having mentorship specific to GH, and being financially supported, especially through bursaries. Areas were also noted to better guide and support GHR emerging researchers. These included providing more support for navigating career transitions and developing a program of research, and removing geographical restrictions to access financial resources, including bursaries and small grants which can directly support the research of students and junior researchers. Overall, the trainees felt that participation in a mentorship program like GHR-CAPS yields multiple benefits including greater academic productivity, network expansion, increased professional confidence, and enhancement of knowledge and skills. It also provides a sense of belonging to something official and important and gives visibility to trainees' work. # Conclusion There is value-added to have mentorship programs like GHR-CAPS. GHR mentorship is optimized by having multiple sources of support for trainees and by implementing diverse strategies to meet trainees' needs and strengthen their capacity.

  • Turenne Charlotte Pailliard, Gautier Lara, Degroote Stéphanie, Guillard Etienne, Chabrol Fanny et Ridde Valéry (2019) « Conceptual analysis of health systems resilience: A scoping review », Social Science & Medicine, 232 (juillet 1), p. 168-180. DOI : 10.1016/j.socscimed.2019.04.020.
    Résumé : System resilience has long been an area of study, and the term has become increasingly used across different sectors. Studies on resilience in health systems are more recent, multiplying particularly since the 2014 Ebola epidemic in West Africa. The World Health Organization (WHO) is calling for national governments to increase the resilience of their health systems. Concepts help define research objects and guide the analysis. Yet, to be useful, concepts need to be clear and precise. We aimed to improve the conceptual understanding of health systems resilience by conducting a scoping review to describe the state of knowledge in this area. We searched for literature in 10 databases, and analyzed data using a list of themes. We evaluated the clarity and the precision of the concept of health systems resilience using Daigneault & Jacob's three dimensions of a concept: term, sense, and referent. Of the 1091 documents initially identified, 45 met the inclusion criteria. Term: multiple terms are used, switching from one to the other to speak about the same subject. Sense: there is no consensus yet on a unique definition. Referent: the magnitude and nature of events that resilient health systems face differ with context, covering a broad range of situations from sudden crisis to everyday challenges. The lack of clarity in this conceptualization hinders the expansion of knowledge, the creation of reliable analytical tools, and the effectiveness of communication. The current conceptualization of health systems resilience is too scattered to enable the enhancement of this concept with great potential, opening a large avenue for future research.
    Mots-clés : Conceptual analysis, Health systems, Health systems resilience, Resilience, Scoping review.

  • Zitti Tony, Gautier Lara, Coulibaly Abdourahmane et Ridde Valéry (2019) « Stakeholder Perceptions and Context of the Implementation of Performance-Based Financing in District Hospitals in Mali », International Journal of Health Policy and Management, 8 (10) (juin 30), p. 583-592. DOI : 10.15171/ijhpm.2019.45.
    Résumé : Background: To improve the performance of the healthcare system, Mali's government implemented a pilot project of performance-based financing (PBF) in the field of reproductive health. It was established in the Koulikoro region. This research analyses the process of implementing PBF at district hospital (DH) level, something which has rarely been done in Africa. Methods: This qualitative research is based on a multiple, explanatory, and contrasting case study with nested levels of analysis. It covered three of the 10 DHs in the Koulikoro region. We conducted 36 interviews: 12 per DH with council of circle's members (2) and health personnel (10). We also conducted 24 non-participant observation sessions, 16 informal interviews, and performed a literature review. We performed data analysis using the Consolidated Framework for Implementation Research (CFIR). Results: Stakeholders perceived the PBF pilot project as a vertical intervention from outside that focused solely on reproductive health. Local actors were not involved in the design of the PBF model. Several difficulties regarding the quality of its design and implementation were highlighted: too short duration of the intervention (8 months), choice and insufficient number of indicators according to the priority of the donors, and impossibility of making changes to the model during its implementation. All health workers adhered to the principles of PBF intervention. Except for members of the district health management team (DHMT) involved in the implementation, respondents only had partial knowledge of the PBF intervention. The implementation of PBF appeared to be easier in District 3 Hospital compared to District 1 and District 2 because it benefited from a pre-pilot project and had good leadership. Conclusion: The PBF programme offered an opportunity to improve the quality of care provided to the population through the motivation of health personnel in Mali. However, several obstacles were observed during the implementation of the PBF pilot project in DHs. When designing and implementing PBF in DHs, it is necessary to consider factors that can influence the implementation of a complex intervention.
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  • Gautier Lara et Ridde Valéry (2018) « Did the learning agenda of the World Bank-administrated Health Results Innovation Trust Fund shape politicised evidence on performance-based financing? A documentary analysis », Sociedade e Cultura, 21 (2) (décembre 17), p. 27-53. DOI : 10.5216/sec.v21i2.56310.
    Résumé : The World Bank, co-funded by Norway and the United Kingdom, created and managed an innovative financing mechanism, the Health Results Innovation Trust Fund (HRITF), to support performance-based financing (PBF) reforms in low- and middle-income countries. From its inception in late 2007, until the closing of fundraising in 2017, it has carried out a wide range of activities related to experimenting PBF. In conjunction with the World Bank, which positioned itself as a “learning organisation”, donors have pushed the HRITF towards developing a specific learning agenda for documenting the policy impact of PBF. This learning agenda has been primarily based on impact evaluations of PBF pilot programmes. As a new body took over the HRITF’s portfolio (Global Financial Facility), a documentary analysis of this learning agenda is timely. Building from public policy concepts that have been applied to social and health policy, and knowledge translation literature, we examine the learning agenda implemented by the HRITF over these 10 years. Our data includes documentation and publications (N=35) on HRITF and from the HRITF online platform. Results indicate that on several fronts, the HRITF shaped some form of politicised knowledge, notably in the ways country pilot grants were designed and evaluated. Some of its learning activities also provided opportunities for a transformative use of knowledge for World Bank staff as well as national implementers and policymakers. We also provide reflections about the HRITF’s preferred approaches to produce knowledgeand learn.

  • Gautier Lara, Tosun Jale, De Allegri Manuela et Ridde Valéry (2018) « How do diffusion entrepreneurs spread policies? Insights from performance-based financing in Sub-Saharan Africa », World Development, 110 (octobre), p. 160-175. DOI : 10.1016/j.worlddev.2018.05.032.

  • Ridde Valéry, Gautier Lara, Turcotte-Tremblay Anne-Marie, Sieleunou Isidore et Paul Elisabeth (2018) « Performance-based Financing in Africa: Time to Test Measures for Equity », International Journal of Health Services, 48 (3) (juillet), p. 549-561. DOI : 10.1177/0020731418779508.
    Résumé : Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030.

  • Turcotte-Tremblay Anne-Marie, Gautier Lara, Bodson Oriane, Sambieni Emmanuel et Ridde Valéry (2018) « Le rôle des acteurs de la santé mondiale dans l’expansion du financement basé sur la performance dans les pays à faible et à moyen revenu. », Journal de Gestion et d’Économie Médicales, 36 (5-6), p. 261-279. DOI : 10.3917/jgem.185.0261.
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