The diffusion of pay for performance in health system reforms in sub-Saharan Africa and the depoliticization of health intervention

Resumen

Since its commencement in Rwanda in 2006, the study of
performance-based financing (PBF) in Africa has focused
research attention on its effects regarding improving the
health care system or achieving health-related Millennium
Development Goals (MDGs). Similarly, critics of PBF have
concentrated more on its inability to transform structural
indicators of the health system positively and sustainably.
So far, the scientific literature has not sufficiently explored
the implications concerning the ideological and operational
mutations that the PBF is operating. This study investigates
these aspects of PBF in conception and operationalization of
public health intervention. The concept of depoliticization of
public health action is proposed in this analysis to describe the
capacity of the PBF to redraw health policy from the realm
of political and State intervention, and from the primacy of
public sector to field of market-based competition between
Government sponsored and non-State actors.