Grant: Travel Awards - Institute Community Support

Background: Communities of practice are flowering in the SDG era, yet their role in diffusing health systems reforms has been seldom investigated. A Community of Practice (CoP) was created to facilitate knowledge exchange on a health systems reform - performance-based financing (PBF). PBF has spread in African countries very rapidly. This study explores the ways in which the CoP contributes to PBF diffusion in African countries. Methods: A mixed methods design was used to document the CoP's participation to diffusion mechanisms, i.e. policy framing, learning, and emulation (eg, how socialisation sparks interest for a policy). A semantic discourse analysis of the CoP's online forum (1,346 messages) was performed. These quantitative results were confronted to qualitative interviews with selected CoP members and PBF experts knowledgeable of the CoP carried out in 2016-2017 (N=43). Social Network Analyses (SNA) of contributors (n=182) were conducted to further investigate how the structure of the CoP shapes policy diffusion. Results: CoP members' framing of PBF typically used economics and management semantic fields. Members' cohesion built around a common defensive tone in reaction to externally-voiced PBF criticism. This brought about a sense of community, potentially inducing emulation among CoP members. The CoP's main promoted learning strategy was to promote South-South knowledge exchanges about PBF practices. The SNA enabled to nuance these findings: the network's structure showed that the CoP is dominated by European individuals. They are driving the framing and emulation strategies, and learning agenda. Discussion: This research identified the critical dimensions of CoPs facilitating health system reforms' diffusion in the SDG era. Still, this mixed method approach can hardly draw causal patterns: CoPs seldom represent the only active policy communities, hence their effective contribution to policy diffusion is difficult to isolate from other networks' actions.