Publications des membres du Ceped


  • Zitti Tony, Fillol Amandine, Lohmann Julia, Coulibaly Abdourahmane et Ridde Valéry (2021) « Does the gap between health workers’ expectations and the realities of implementing a performance-based financing project in Mali create frustration? », Global Health Research and Policy, 6 (1) (février 2), p. 5. DOI : 10.1186/s41256-021-00189-0.
    Résumé : Background Performance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating health workers. The purpose of this research was to identify and understand how health workers’ expectations related to their experiences of the first cycle of payment of PBF subsidies, and how this experience affected their motivation and sentiments towards the intervention. We pose the research question, “how does the process of PBF subsidies impact the motivation of health workers in Mali?” Methods We adopted a qualitative approach using multiple case studies. We chose three district hospitals (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each DH. We analyzed data in a mixed deductive and inductive manner. Results The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work more efficiently. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention. Conclusion The PBF implementation in Mali left health workers frustrated. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. This underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.


  • 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.


  • Coulibaly Abdourahmane, Zitti Tony, Ridde Valéry et Dagenais Christian (2019) « La vérification communautaire du FBR au Mali: encore du chemin à faire! ».
  • Fillol Amandine, Djiguinde Amadou, Coulibaly Abdourahmane, Zitti Tony et Ridde Valéry (2019) « Les problèmes de mise en œuvre nuisent à l’augmentation de la motivation des agents de santé au Mali », ONG MISELI.
    Résumé : Au Mali, un programme de financement basé sur les résultats (FBR) a été mis en oeuvre dans la région de Koulikoro en 2016-2017. Cette note présente les résultats d’une étude qui a permis d’observer que ce programme pourrait augmenter la motivation du personnel de santé. L’idée des primes est très appréciée par les agents mais les problèmes de mise en oeuvre sont un obstacle important. Nous avons proposé plusieurs recommandations à la fin de cette note afin de limiter les effets des problèmes de mise en œuvre.

  • 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.
    Pièce jointe Texte intégral 649.2 ko (source)


  • Coulibaly Abdourahmane, Zitti Tony, Ridde Valéry et Dagenais Christian (2018) « Les défis de l’accès aux connaissances et à l’information lors du démarrage d’un projet FBR au Mali ».

  • Coulibaly Abdourahmane, Zitti Tony, Ridde Valéry et Dagenais Christian (2018) « La mise en œuvre du FBR dans les CSCom au Mali: quelles leçons retenir ? ».

  • Coulibaly Abdourahmane, Zitti Tony, Ridde Valéry et Dagenais Christian (2018) « Les problèmes liés au choix des indicateurs dans le cadre de la mise en œuvre du FBR au Mali », Miseli, l'Anthropologie dans le développement.

  • Zitti Tony, Coulibaly Abdourahmane, Ridde Valéry et Dagenais Christian (2018) « Le payement des primes individuelles liées au FBR au Mali: les consignes officielles sont-elles indispensables ? », Miseli, l'Anthropologie dans le développement.
    Résumé : Les primes FBR ont été payées aux agents des centres de santé de référence (CSRéf) et des centres de santé communautaire (CSCom) avec plusieurs mois de retard. Selon les procédures définies par les concepteurs du projet, le calcul des primes devrait tenir compte du niveau de diplôme, des résultats quantitatifs et qualitatifs de chaque agent. L’étude a montré que la distribution des primes s’est déroulée de manière différente d’une formation sanitaire à une autre et qu’elle a peu respecté les procédures. Cette note donne des détails sur ces différents constats et formule des recommandations pour aider les décideurs à mieux organiser le partage des primes lors de la mise en œuvre des futurs projets.
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