Maximising the effectiveness of multi-platform networks in health and development: A case study of Be-Cause Health

Background: Networks have become a widely-used approach to address the complexity of issues around international health and health equity, and many types of networks have been described. The added value of networking is not straightforward and it should be documented. Be-Cause Health (BCH) is a unique, multistakeholder network linking the Belgian actors of the health and development sector, creating a partnership to support their commitment to equitable health. Consequently, BCH has very broad objectives with creative and dynamic outcomes. The aim of this study was to explore if the structure and process of the BCH network could be adapted to improve its effectiveness. Methods: The overall framework of the project included a narrative literature review combined with qualitative semi-structured interviews. The literature review looked at the structure and process of networks and the means of evaluating network effectiveness. The results of this review were used to inform the interviews of key Be-Cause Health members. Results: The reviewed articles illustrate the diversity of networking activities and the complexity of their evaluation, suggesting the use of participative evaluation methods to capture the intangible outcomes as experienced by the members themselves. The interviewees reported that the major benefits of their BCH membership were information sharing and connecting with peers. They felt the growth of the BCH network was mostly related to its culture of trust among members, to the inspiring leadership, to the concrete activities it could organise, to its flexible structure tailored to their needs,and to the support of the secretariat and to the embeddedness of the network in a wider institution with secured public funding. They identified a need for improved internal and external communication and for more concrete objectives of the working groups. Conclusion: The BCH network is a unique response to the complex challenges of health equity and development. The outcomes of such complex networks cannot be measured with a simple quantitative method, and require participative methods of evaluation. There is no formula to predict the change of effectiveness that would result from a change of structure

Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

Abstract Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC) followed suit through a health system strengthening (HSS) project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods: An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results: Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms), as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and sustainability issues are also discussed. Conclusion: BTC’s alternative PBF approach is both promising in terms of effects, ownership and sustainability, and less resource consuming. This experience testifies that PBF is not a uniform or rigid model, and opens the policy ground for recipient governments to put their own emphasis and priorities and design ad hoc models adapted to their context specificities. However, integrating PBF within the normal functioning of local health systems, in line with other reforms, is a big challenge

Building a concept map on people-centred care

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Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

Background: Performance-based financing (PBF) is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC) followed suit through a health system strengthening (HSS) project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods: An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results: Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms), as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and sustainability issues are also discussed. Conclusion: BTC’s alternative PBF approach is both promising in terms of effects, ownership and sustainability, and less resource consuming. This experience testifies that PBF is not a uniform or rigid model, and opens the policy ground for recipient governments to put their own emphasis and priorities and design ad hoc models adapted to their context specificities. However, integrating PBF within the normal functioning of local health systems, in line with other reforms, is a big challenge.ARC Effi-Sant

Renforcement des systèmes de santé: Capitalisation des interventions de la Coopération Belge au Burundi, en RDC et au Rwanda

Actes de l'Atelier Régional Santé :Rubavu, Rwanda. Du 12 au 15 septembre 2011info:eu-repo/semantics/publishedL'Harmattan, Paris