La pérennisation de programmes de financement basé sur les résultats : étude de cas au Mali

Le financement basé sur les résultats (FBR) est un type de financement de plus en plus utilisé dans les systèmes de santé en Afrique. Au Mali, un projet pilote de FBR a été implanté afin d’améliorer l’offre et la qualité des soins, en ciblant des services payés à la performance. Aucune étude n’a encore été publiée pour comprendre le processus de pérennisation d’un tel programme en Afrique ou pour évaluer la pérennité de ses résultats; ceci étant le but de la recherche. La pérennisation a été analysée à travers ses différents déterminants, phases, niveaux et contextes. Ces composantes ont été explorées par différents événements critiques permettant d’obtenir une notion partagée par les parties prenantes de la pérennité du projet. Six centres de santé communautaire et deux centres de référence ont été choisis comme sites. Quarante-neuf entretiens ont été conduits avec les différentes parties prenantes (prestataires de soins, direction, gestionnaires, membres du projet) à divers niveaux administratifs (aires de santé, district, régional et national). Une analyse thématique a été effectuée à l’aide du logiciel © QDA Miner. Les résultats montrent que le niveau de pérennité du projet est faible pour plusieurs raisons. Concernant les déterminants de pérennité, l’investissement de ressources s’est arrêté à la fin du projet, peu de partage culturel se déroulait autour du FBR, peu de nouvelles tâches ont perduré et le projet n’était pas totalement adapté/approprié pour/par tous les acteurs. Peu d’événements critiques permettent de retracer les différentes phases de pérennisation, cependant, un manque de planification au niveau de la pérennité du projet est constaté. Des questions peuvent donc être posées quant à l’approche par projet et les gains potentiels qui pourraient être effectués grâce à une meilleure compréhension et opérationnalisation du concept de pérennité.Performance-based financing (PBF) is emerging as a new alternative to finance health systems in many African countries. In Mali, a pilot project was conducted to improve demand and supply of health services through financing performance. No study has explored the sustainability process of such a project in Africa. This study’s objectives were to understand the sustainability process of the project and to assess its level of sustainability. The process of sustainability was examined through its different determinants, stages and contexts. These were explored in interviews to discern, via critical events, stakeholders’ ideas regarding sustainability in terms of this project. Forty-nine stakeholders were interviewed in six community health centres and two referral health centres, including health practitioners, administrators (at district, regional, national levels), and those involved in implementing and conceptualizing the program (government and NGOs). A theme analysis was done with the software © QDA Miner. The results show a weak level of sustainability of the project due to many factors. Concerning determinants of sustainability, investments stopped at the end of the project, insufficient cultural artefacts were shared around PBF, few new tasks lasted after the project and the latter was not fully adapted/owned for/by the stakeholders. Few critical events were associated to stages of sustainability; however, a lack of planning could be seen linked to sustainability. Therefore, questions can be asked regarding the project approach and the potential gains that could be made through a better comprehension and operationalisation of the sustainability concept

Benchmarking in (meta-) genomics: LEMMI & BUSCO

La quantité d'informations obtenue lors de l'étude de génomes augmente de façon constante. La complexité des processus de séquençage conduit à des données imparfaites avec un niveau élevé de bruit. Celles-ci nécessitent une variété de méthodes pour donner une interprétation biologique à leur contenu. Comme certains résultats reflètent mieux la réalité que d'autres, des stratégies pour juger de la qualité des données et des performances des méthodes informatiques sont nécessaires pour guider les choix expérimentaux. Ces évaluations doivent être systématiques et reproductibles. J'explore ici deux aspects liés à l'évaluation de processus informatiques dédiés à la recherche biologique, ainsi que de leurs résultats. Ils sont abordés au travers de deux ressources bio-informatiques distinctes dédiées à l'évaluation des performances (benchmark). i) La plate-forme LEMMI fournit une évaluation continue des outils de classification taxonomique. ii) Le logiciel BUSCO utilise des gènes conservés universellement pour évaluer le niveau de complétion de séquences génomiques

2. L’évaluation de la pérennité

Le financement basé sur les résultats (FBR) est un type de réforme du financement du système de santé très populaire en Afrique. Plusieurs projets pilotes sont mis en œuvre dans le but d’offrir plus de soins de santé ainsi que d’en améliorer la qualité. Cependant, la pérennisation de ce type d’intervention en Afrique a encore été trop peu étudiée. Ce chapitre explique donc comment la pérennité de cette intervention a été évaluée au moyen d’une méthodologie qualitative. En lisant ce chapitre, on pourra mieux comprendre le processus de recherche qui a été mis en œuvre grâce à sa présentation exhaustive, de la première étape (ex. : la réalisation d’une revue de la littérature) jusqu’à la dernière (ex. : l’attribution du niveau de pérennité de l’intervention). Une section plus réflexive permet aussi aux lecteurs et lectrices de s’immiscer davantage dans l’expérience des chercheurs en ayant une meilleure compréhension des défis rencontrés (tant méthodologiques que professionnels) et des leçons apprises.Results-Based Financing (RBF) is a new type of health financing reform that is very popular in Africa. Several pilot projects are being implemented on this continent, and elsewhere, to provide better and more health care services. However, too little research has been done on the sustainability of this type of intervention in Africa. This chapter explains how this intervention was evaluated, through the concept of sustainability, and following a qualitative methodology. By reading this chapter, we will be able to better understand the research process that has been carried out thanks to its exhaustive presentation, from thefirst step (e.g. the completion of a review of the literature) to the last (e.g. the attribution of the level of sustainability of the intervention). A more reflexive section also allows readers to become more involved in the researcher’s expérience by having a better understanding of the challenges encountered (both methodological and professional) and the lessons that they have learned.Résumé en bambara, traduit par Ahamadou Diakité et Mahamadou Diabaté que nous remercions Nafolo ko mi siysin né do diabi sorolila (FBR) yé nafolo taabolo kura yé mi maakadi keneya kan farafina kono. Poroje kuntiléna ciaman be sékan walassa ka sé ko furakeli lagini boqan ka yɛlɛ mali do a la ani ka kɛcioɳoya ɳuma kɛ o hokumu kono taabolo bilali sé kan kuolaye farafina kono kalan ciamaba ma a siηi sé kan o la. Ni Bolofara ɳinfoli ba yira ciokodi taabolo kudayi diatemildi kεra ni baara mine, ɳinini taabolo bolé yuman na. Ni Bolofara kalan ni na, ɳinini taabolo fouamu bibali la sé kan sannan yɛlin yirali la ni kalan biolo folonɳi (Misali la : o ηafé sebeni waleyali la) fo lavan (Misali la : taabolokudayi diaté dero dili la). Hakilina baara bolodali boyan k ata a fɛ ki sé do a ko la ksbɛ ɳinini kela yé dniya mi soro ɳeleya minounou yéra faamu cioko yuman na (kaata o kalan taabolo ni o baara taabolo) ani fouamu mi soro la kono

LEMMI: a continuous benchmarking platform for metagenomics classifiers

Studies of microbiomes are booming, along with the diversity of computational approaches to make sense out of the sequencing data and the volumes of accumulated microbial genotypes. A swift evaluation of newly published methods and their improvements against established tools is necessary to reduce the time between the method's release and its adoption in microbiome analyses. The LEMMI platform offers a novel approach for benchmarking software dedicated to metagenome composition assessments based on read classification. It enables the integration of newly published methods in an independent and centralized benchmark designed to be continuously open to new submissions. This allows developers to be proactive regarding comparative evaluations and guarantees that any promising methods can be assessed side-by-side with established tools quickly after their release. Moreover, LEMMI enforces an effective distribution through software containers to ensure long term availability of all methods. Here, we detail the LEMMI workflow and discuss the performances of some previously unevaluated tools. We see this platform eventually as a community-driven effort where method developers can showcase novel approaches and get unbiased benchmarks for publications, while users can make informed choices and obtain standardized and easy-to-use tools

BUSCO: assessing genome assembly and annotation completeness

Genomics drives the current progress in molecular biology, generating unprecedented volumes of data. The scientific value of these sequences depends on the ability to evaluate their completeness using a biologically meaningful approach. Here, we describe the use of the BUSCO tool suite to assess the completeness of genomes, gene sets, and transcriptomes, using their gene content as a complementary method to common technical metrics. The chapter introduces the concept of universal single-copy genes, which underlies the BUSCO methodology, covers the basic requirements to set up the tool, and provides guidelines to properly design the analyses, run the assessments, and interpret and utilize the results

Scaling-Up Performance-Based Financing in Burkina Faso: From PBF to User Fees Exemption Strategic Purchasing

Background: Numerous countries have undertaken performance-based financing (PBF) reforms to improve quality and quantity of healthcare services. However, only few reforms have successfully managed to achieve the different scale-up phases. In Burkina Faso, a pilot project was implemented, but was put on hold before being scaled. During the writing of this article, discussions to scale-up were still ongoing on a national strategic purchasing strategy within a government led user fee exemption policy. Methods: This study’s objective is to identify facilitators and barriers to scaling-up for that pilot, based on the World Health Organization’s (WHO’s) theoretical framework. Interviews were conducted in three health centres and in Ouagadougou to discuss the scale-up with different actors. The software QDA Miner© was used to help in the framework analysis. Results: The low involvement of some key stakeholders (mainly decision-makers) and the unstable context hindered ownership of the project, thus its priority on the political agenda. PBF reform therefore lost its momentum to the benefit of a user fee exemption policy. This latter program was seen to be more beneficial since it addressed access to healthcare services, in comparison to service quality, which was the PBF’s relative advantage. A scale-up of some PBF elements (eg, strategic purchasing tools) is however still in discussion in 2019, but would be integrated within the user fee exemption program. Increased costs during the PBF’s implementation gave the impression that the project was too costly and not scalable. The involvement of an important funding agency (World Bank, WB) also fed the impression of high costs, which demotivated the actors, especially decision-makers. Conclusion: Contextual factors remain central to the implementation of PBF, while their evaluation and mitigation have remained unclear. The participation of key actors in scaling-up operations and the use of social science as tools to better understand the context is therefore primordial

Scaling-Up Performance-Based Financing in Burkina Faso: From PBF to User Fees Exemption Strategic Purchasing

International audienceBACKGROUND: Numerous countries have undertaken performance-based financing (PBF) reforms to improve quality and quantity of healthcare services. However, only few reforms have successfully managed to achieve the different scale-up phases. In Burkina Faso, a pilot project was implemented, but was put on hold before being scaled. During the writing of this article, discussions to scale-up were still ongoing on a national strategic purchasing strategy within a government led user fee exemption policy. METHODS: This study’s objective is to identify facilitators and barriers to scaling-up for that pilot, based on the World Health Organization’s (WHO’s) theoretical framework. Interviews were conducted in three health centres and in Ouagadougou to discuss the scale-up with different actors. The software QDA Miner© was used to help in the framework analysis. RESULTS: The low involvement of some key stakeholders (mainly decision-makers) and the unstable context hindered ownership of the project, thus its priority on the political agenda. PBF reform therefore lost its momentum to the benefit of a user fee exemption policy. This latter program was seen to be more beneficial since it addressed access to healthcare services, in comparison to service quality, which was the PBF’s relative advantage. A scale-up of some PBF elements (eg, strategic purchasing tools) is however still in discussion in 2019, but would be integrated within the user fee exemption program. Increased costs during the PBF’s implementation gave the impression that the project was too costly and not scalable. The involvement of an important funding agency (World Bank, WB) also fed the impression of high costs, which demotivated the actors, especially decision-makers. CONCLUSION: Contextual factors remain central to the implementation of PBF, while their evaluation and mitigation have remained unclear. The participation of key actors in scaling-up operations and the use of social science as tools to better understand the context is therefore primordial

Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali

Résumé Contexte Le financement basé sur les résultats (FBR) est. un type de financement de plus en plus utilisé dans les systèmes de santé en Afrique. Au Mali, un projet pilote de FBR a été implanté afin d’améliorer l’offre et la qualité des soins, en ciblant des services payés à la performance. Aucune étude n’a encore exploré le processus de pérennisation d’un tel. programme en Afrique. Les objectifs de cette étude étaient de mieux comprendre le processus de pérennisation du projet et d’évaluer son niveau de pérennité. Méthodologie La pérennisation a été analysée à travers ses différents déterminants, phases, niveaux et contextes. Quarante-neuf entrevues ont été effectuées dans six centres de santé communautaire et deux centres de santé de référence (de 11/12/15 à 08/03/16) avec des prestataires de soins, gestionnaires et ceux impliqués dans l’implantation et conceptualisation du projet (gouvernement et ONGs). Les sites de collecte de données ont été choisis avec la participation de différentes parties prenantes et sur la base de différents critères (contexte rural/urbain, niveau de participation, participants FBR toujours présents, etc.). Une analyse thématique a été conduite avec le logiciel QDA Miner © en lien avec le cadre conceptuel de l’étude. Résultats Les résultats montrent que le niveau de pérennité du projet est. faible pour plusieurs raisons. Lorsque certains gains ont pu être maintenus (ex.: investissements dans des ressources à long-terme, compatibilité des valeurs et codes, design adapté aux contextes d’implantation, etc.), d’autres n’ont pu l’être (ex.: fin des investissements, manque de partage d’artefacts culturels autour du FBR, perte de tâches et procédures FBR, besoin d’appropriation du projet par les parties prenantes). Un manque de planification de la pérennité a été observé, et peu d’événements critiques ont été associés aux phases de la pérennisation. Conclusions Si ce projet FBR visait à l’augmentation de la motivation des agents de santé via différents mécanismes (supervision, investissements, primes, etc.), ces résultats amènent à se poser des questions sur quels types de motivation serait plus stables et quelle serait la place des parties prenantes; tout ceci avec le but d’obtenir des résultats plus efficients et pérennes

Genomic signatures accompanying the dietary shift to phytophagy in polyphagan beetles

Background: The diversity and evolutionary success of beetles (Coleoptera) are proposed to be related to the diversity of plants on which they feed. Indeed, the largest beetle suborder, Polyphaga, mostly includes plant eaters among its approximately 315,000 species. In particular, plants defend themselves with a diversity of specialized toxic chemicals. These may impose selective pressures that drive genomic diversification and speciation in phytophagous beetles. However, evidence of changes in beetle gene repertoires driven by such interactions remains largely anecdotal and without explicit hypothesis testing. Results: We explore the genomic consequences of beetle-plant trophic interactions by performing comparative gene family analyses across 18 species representative of the two most species-rich beetle suborders. We contrast the gene contents of species from the mostly plant-eating suborder Polyphaga with those of the mainly predatory Adephaga. We find gene repertoire evolution to be more dynamic, with significantly more adaptive lineage-specific expansions, in the more speciose Polyphaga. Testing the specific hypothesis of adaptation to plant feeding, we identify families of enzymes putatively involved in beetle-plant interactions that underwent adaptive expansions in Polyphaga. There is notable support for the selection hypothesis on large gene families for glutathione S-transferase and carboxylesterase detoxification enzymes. Conclusions: Our explicit modeling of the evolution of gene repertoires across 18 species identifies putative adaptive lineage-specific gene family expansions that accompany the dietary shift towards plants in beetles. These genomic signatures support the popular hypothesis of a key role for interactions with plant chemical defenses, and for plant feeding in general, in driving beetle diversification