Performance-Based Financing (PBF) in Mali: is it legitimate to speak of the emergence of a public health policy?

Abstract

Performance-based financing (PBF) is just one of a number of recent experiments implemented in Mali to improve maternal and child health indicators. This article presents a qualitative study based on Kingdon’s (1984) multiple streams theory and an approach inspired by development anthropology. The aim was to describe the forms of national ownership of PBF and to determine whether it is possible to speak of the emergence of a PBF public policy in Mali at this stage. The contribution of this study is both theoretical (understanding the emergence of a policy) and empirical (roles of local and international actors). The data came from 33 qualitative interviews conducted with individuals representing various institutions, notably the Ministère de la Santé. The results suggest there has been no emergence of a PBF public policy in Mali due to a myriad of constraints, including an insufficient number of political entrepreneurs, windows of opportunity and funding partners as well as the short duration of the pilot projects.