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Sustainability determinants of the Burkinabe performance-based financing project

Mathieu Seppey (École de santé publique, Université de Montréal, Montréal, Canada)
Paul-André Somé (AGIR (Action-Gouvernance-Intégration-Renforcement): Groupe de travail en Santé et Développement, Ouagadougou, Burkina Faso)
Valéry Ridde (CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France) (Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Sénégal)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 5 February 2021

Issue publication date: 5 May 2021




A performance-based financing (PBF) pilot project was implemented in 2011 in Burkina Faso. After more than five years of implementation (data collection in 2016), the project's sustainability was not guaranteed. This study's objective is to assess this project's sustainability in 2016 by identifying the presence/absence of different determinants of sustainability according to the conceptual framework of Seppey et al. (2017).


It uses a case study approach using in-depth interviews with various actors at the local, district/regional and national levels. Participants (n = 37) included health practitioners, management team members, implementers and senior members of health directions. A thematic analysis based on the conceptual framework was conducted, as well as an inductive analysis.


Results show the project's sustainability level was weak according to an unequal presence of sustainability's determinants; some activities are being maintained but not fully routinised. Discrepancies between the project and the context's values appeared to be important barriers towards sustainability. Project's ownership by key stakeholders also seemed superficial despite the implementers' leadership towards its success. The project's objective towards greater autonomy for health centres was also directly confronting the Burkinabe's hierarchical health system.


This study reveals many fits and misfits between a PBF project and its context affecting its ability to sustain activities through time. It also underlines the importance of using a conceptual framework in implementing and evaluating interventions. These results could be interesting for decision-makers and implementers in further assessing PBF projects elsewhere.



The authors would like to thank Fabienne Sondo and Hortense Kere for their flexibility and understanding as data collection partners and interpreters during the data collection process. The authors extend thanks to all the AGIR interpreters for the transcriptions as well as for their long and hard work. Thanks also to Ahmed Barro for all the much needed coordination work as well as to Loubna Belaid, Gabriel Girard and Amandine Fillol for their recommendations during the analysis and writing process. Thanks to Matthew Rettino and Heather Hickey for the review.This work has been conducted with the financial support of the initiative “Innovation for mothers and children's health in Africa” which was granted by the Ministry of External Affairs, Commerce and Development of Canada, the Canadian Institutes of Health Research and the International Development Research Centre. These organisations did not have any role in the design of the study, the collection, the analysis or other parts of the research.


Seppey, M., Somé, P.-A. and Ridde, V. (2021), "Sustainability determinants of the Burkinabe performance-based financing project", Journal of Health Organization and Management, Vol. 35 No. 3, pp. 306-326.



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