The document outlines a study investigating the diffusion and domestic ownership of performance-based financing (PBF) in Mali, highlighting the challenges and methods used. It discusses the diffusion mechanisms of policy emulation, learning, cooperation, and framing among national elites, revealing issues of miscommunication and limited collaboration during implementation. The study emphasizes the importance of a policy diffusion framework in understanding the integration of PBF within Mali's health policy landscape.

1. Using the policy diffusion framework to
investigate domestic ownership of PBF in Mali:
methodological and practical challenges
METHODS FOR IMPLEMENTATION SCIENCE
IN GLOBAL HEALTH
April, 20th. 2017
McGill University
Workshop co-organised by REALISME Chair and McGill of Global Health Programs
Lara Gautier

2. Context
• Over the past decade, several donors have promoted PBF in Africa, in view of
• increasing the quantity and quality of health services provision
• improving health providers' financial and managerial autonomy
• improving health providers’ accountability
• In Mali, after participating in a prepilot PBF program, the Ministry of Health and Public
Hygiene
– included PBF in its national strategic plan
– engaged in a regional scale-up of this strategy
• using external funding
• requesting technical assistance from other African countries

3. Objectives of the study
• Document the ways in which PBF was gradually diffused across Mali's national
elites (experts and policymakers at both the central and decentralised levels),
thereby improving their ownership of the policy
• We investigate this diffusion through an analysis of three typical diffusion
mechanisms:
– Policy emulation
– Policy learning
– Policy cooperation
• To which we add one recently-incorporated mechanism (Gilardi, 2017)
– Policy framing
Main challenge: multiple locations of PBF implementation:
e.g. which jurisdiction/level learns from who?

4. Method
• Multiple datasources are sought
1. national experts' and policymakers' documentation on PBF in Mali (N=51) by
running a semantic content analysis (using Semato©)
– This notably enabled to identify the major ideas, beliefs, and values associated with PBF
2. qualitative data: meeting observation notes (N=5) and qualitative interviews (N=26)
with national PBF experts and policymakers, as well as international technical
assistants and funders of PBF in Mali
• Datasets are triangulated in order to bring out consistent findings on
how PBF is framed in the national discourse, and what shaped the
mechanisms of emulation, learning, and cooperation
Main challenge: finding strategies to move beyond central
actors’ (apparently) consensual discourse about PBF

5. (preliminary)
Results
• PBF is framed as the logical continuation of
existing policies of decentralisation and new public
management. PBF is also conceived as a means to
improve quality of care.
– This framing shapes national elites' initial
engagement in PBF
• Main source of national elites’ emulation was the
existence of longstanding trust relationships
between national policymakers and PBF experts
outside Mali
– BUT high turnover
• Learning initiated by international and African
experts through training sessions and study tours
outside Mali
– Little learning between decentralized & central actors
• No cooperation during the regional scale-up
– Manifest miscommunication and misunderstanding
between the funder and national elites.
Domestic ownership
of “PBF à la
malienne“ assessed
through diffusion
mechanisms

6. Lessons learned for
implementation
science in global
health
Strengths
• Usefulness of the policy diffusion framework in IS
• Originality of this political science approach
• Relatively easy to fit with complex and various
datasources
• Can be used with a mixed methods approach
Limits
• Challenges in defining appropriate levels of
jurisdictions to focus on (for investigating the
diffusion mechanisms)
• Framework most commonly used for drawing
causal patterns empirically – not from IS angle

7. Going further
• Berry, F. S., and Berry, W.D. (2007). Innovation and Diffusion Models in Policy
Research. In Theories of the Policy Process, ed. Paul A. Sabatier. Second edition.
Boulder, CO: Westview Press, 223-260.
• Dalglish, S. L., George, A., Shearer, J. C., & Bennett, S. (2015). Epistemic
communities in global health and the development of child survival policy: a case
study of iCCM. Health policy and planning, 30(suppl 2), ii12-ii25.
• Gilardi F. (2012). Transnational diffusion: Norms, ideas, and policies. Handbook of
international relations, 2; 453-477.
• Gilardi F., Shipan C.R., and Wueest B. (2017). The Diffusion of Policy Frames:
Evidence from a Structural Topic Model. Forthcoming, URL available from:
http://www.fabriziogilardi.org/resources/papers/diffusion-policy-frames.pdf

8. Let’s discuss together!
Meet the experts
Thank you for your attention