The diffusion of pay for performance in health system reforms in sub-Saharan Africa and the depoliticization of health intervention

Since its commencement in Rwanda in 2006, the study ofperformance-based financing (PBF) in Africa has focusedresearch attention on its effects regarding improving thehealth care system or achieving health-related MillenniumDevelopment Goals (MDGs). Similarly, critics of PBF haveconcentrated more on its inability to transform structuralindicators of the health system positively and sustainably.So far, the scientific literature has not sufficiently exploredthe implications concerning the ideological and operationalmutations that the PBF is operating. This study investigatesthese aspects of PBF in conception and operationalization ofpublic health intervention. The concept of depoliticization ofpublic health action is proposed in this analysis to describe thecapacity of the PBF to redraw health policy from the realmof political and State intervention, and from the primacy ofpublic sector to field of market-based competition betweenGovernment sponsored and non-State actors.