Grant: Travel Awards - Institute Community Support

Background: Over the past decade, several donors have promoted performance-based financing (PBF) in Africa, in view of increasing the quantity and quality of health services. In Mali, after co-organising a pilot PBF program, the Ministry of Health included PBF in the national policy. We investigate PBF policymaking through an analysis of the multifaceted legitimation processes occurring at the global, continental, and national levels. We posit that the constitution in networks, the production and dissemination of PBF knowledge-based resources, and the construction of a nationally-adapted narrative of PBF are instrumental in shaping policymaking. Methods: We adopt a mixed methods approach to collect and analyse data. PBF legitimation at global and continental levels is investigated quantitatively through network and discourse analyses of online resources from major PBF platforms, and qualitatively with interviews of key PBF promoters. PBF legitimation at national level is examined through another round of interviews with stakeholders involved in PBF discussions in Mali. Preliminary findings: Following preliminary network and discourse analyses, and an exploratory study in Bamako, three main results emerge: i) there is a very active PBF policy community at the global and continental levels: it gravitates around a more restricted PBF policy elite made up of consultants and donors' staff producing and disseminating PBF knowledge; ii) in Mali, a few former government officials and technical officers showed strong commitment to PBF after receiving training; iii) these national promoters frame PBF as the logical continuation of pre-existing policies. Discussion: These preliminary findings prompt further investigations, which will inform policymaking processes through an original approach. This is the first research focusing on a variety of legitimating processes towards the diffusion of an innovation (PBF) in Africa, and in a particular setting (Mali).