1.
Combining methods to
explore the contribution
of the
to policy diffusion
in Africa
#HSR2018
Lara GAUTIER*, Manuela DE ALLEGRI, Valéry RIDDE
*University of Montreal & Université Sorbonne Paris Cité

2.
RATIONALE
Very fast diffusion of PBF across
Subsaharan Africa
© Lara Gautier, 2018
Kaplan-Meier Plot for PBF Diffusion, 2000-2017

3.
Transnational diffusion entrepreneur (Gautier et
al., 2018)
+2000 members, migrating to “Collectivity”
© Lara Gautier, 2018
STUDY FOCUS & RESEARCH QUESTION
How did the PBF CoP contribute to shape policy
diffusion?
*Framing PBF -- common language
*Inducing emulation -- socialisation
*Shaping policy learning
*Facilitating policy experimentation

4.
QUAN
Semantic discourse
analysis of the CoP
online forum -- framing
Social network analysis
-- emulation and learning
METHODS
QUAL
Thematic analysis of in-
interviews, observation
notes & documentation
(guided by ‘diffusion
entrepeneurs’ framework)
-- framing, emulation,
learning, and
experimentation
*Mixed methods study using a concurrent design

5.
DATASETS
• Textual data: 1,346 online posts
– Semantic discourse analysis
• Relational data: 285 active CoP members
– Social network analysis
• 40 interviews with key informants
• 4 observation notes
• 25 documents on the CoP
– Thematic analysis
© Lara Gautier, 2018

6.
© Lara Gautier, 2018 Analyses: QDAMiner®
45,0%
37,5%
38,2%
12,0%
SEMANTIC ANALYSES

7.
Citing another CoP member…
*creates a sense of belonging to the PBF
community
*recognises their contribution to PBF
knowledge
>> thus expanding policy emulation and
learning
© Lara Gautier, 2018
SNA HYPOTHESIS

8.
Kamada Kawai algorithm
-- R
CoP core group (6
people)
Non-members of the
CoP
NB: Size of node
= nb of times citing s.o.
(weighted degree
centrality)
© Lara Gautier, 2018
SNA: CITATIONS BY COP MEMBERS

9.
MOST CITED PEOPLE, 2010-2016 (1,346
POSTS)
Cited people
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010-2012
2013-2016
2010-2012
2013-2016
50,0%
44,1%
65.8%
47.9%
50.0%
55.9%
34.2%
52,1%
Citations (Nb times cited)
LMICs
HICs
© Lara Gautier, 2018

10.
Increasing contribution (& citation) of LMIC/African CoP
members (1/2 to 2/3)
• African ownership of the CoP?
• Coherent with facilitator’s explicit strategy to make it
“a community of African experts” (KI19_ACADINST)
YET
*African members do not get cited as much as they
participate (~1/2 vs. 2/3)
*When counting nb of times members get cited, HIC
experts have the lead:
• 49 members got cited > 5 times
• Among those, > 50% HIC experts (25/49)
>> Still much better than global policymaking arenas…
© Lara Gautier, 2018
EVOLUTION OF THE NETWORK

11.
POLICY FRAMING
© Lara Gautier, 2018
• Formulating a clear vision and definition of PBF
“We need to define better what we mean by this 'PBF'
approach. The experience that we developed in Rwanda,
whose lessons are being applied to Burundi, and to
Zambia […]. This is the story. It needs to be written up.”
(Core group member, February 2010)
• Developing and appropriating a PBF language
that speaks to CoP members’ background
• Consensual forum discussions
• PBF as a solution “finally” addressing some
critical issues of health providers in Africa
 A solution propelled by “African practitioners”

12.
“Safe-guarding” the lessons learnt on past PBF
experiences
• “Consolidating the body of operational knowledge”
(Concept note for the PBF CoP, 2010)
Generate and share knowledge about PBF practice
• Multiple activities and innovative formats
© Lara Gautier, 2018
POLICY LEARNING
POLICY EXPERIMENTATION
• Offering international organisations & consulting
companies a pool of African experts to tap into
CoP = a “market place” of PBF practitioners?

13.
POLICY EMULATION
© Lara Gautier, 2018
“Expanding the community of African experts on PBF”
(Concept note for the PBF CoP, 2010)
”What networks do, and one of their major forces is that very
quickly you have a large number of people who seem to
support the same concept. For me, this CoP is a powerful
tool [...] given the mass of people that it represents.”
Members providing support at country level;
de-isolating effect
”People are proud to say they are members. [...] When a
policy entrepreneur starts introducing PBF in his country,
he’s got at least dozens of other people [...] who talk about
it... and that facilitates diffusion.” (KI34_ACADINST)

14.
WHAT CAN BE
LEARNT FROM
THESE
ANALYSES?

15.
CONTRIBUTION TO DIFFUSION?...
OR TO POLICY EMULATION?
• Common framing (language/understanding) of
PBF, often using prescriptive tone
>> risk of an inward-looking community?
• Promoting practitioners’ peer-to-peer learning on
PBF implementation (vs. academic evidence?)
• Transfer of technical expertise from North to
South and replicated >> too much reliance?
© Lara Gautier, 2018

16.
• Largely retrospective; little participant
observation
• This approach is not fit for drawing causal
patterns
– CoP = not the only active PBF network on the
African continent
• Influence difficult to isolate from other networks’
influence
STUDY CHALLENGES & LIMITATIONS
© Lara Gautier, 2018

17.
STUDY VALUE
© Lara Gautier, 2018
• Increasing polycentrism in global health
governance = critical to understand the
role(s) played by (new) transnational
actors
• Mixed methods mobilising innovative tools
prove to be useful to unfold complex forms
of influence

18.
Email: lara.gautier@umontreal.ca
Twitter: @Lara_Gautier