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Open Access 01-12-2017 | Research

Setting performance-based financing in the health sector agenda: a case study in Cameroon

Authors: Isidore Sieleunou, Anne-Marie Turcotte-Tremblay, Jean-Claude Taptué Fotso, Denise Magne Tamga, Habakkuk Azinyui Yumo, Estelle Kouokam, Valery Ridde

Published in: Globalization and Health | Issue 1/2017

Abstract

Background

More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon.

Methods

The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis.

Results

By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change.

Conclusion

The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers’ actions and choices.

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Sachs JD. From millennium development goals to sustainable development goals. Lancet. 2012;379(9832):2206–11. http://dx.doi.org/10.1016/S0140-6736(12)60685-0 PubMedCrossRef

United Nations. Resolution adopted by the General Assembly on 25 September 2015. United Nations; 2015. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E. Accessed 8 July 2017.

World Health Assembly. Health in the 2030 Agenda for Sustainable Development. Report No.: A69/15. 2016. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_15-en.pdf. Accessed 27 April 2017.

Ottersen T, Elovainio R, Evans DB, McCoy D, Mcintyre D, Meheus F, et al. Towards a coherent global framework for health financing: recommendations and recent developments. Health Econ Policy Law. 2017;12(2):285–96. https://doi.org/10.1017/S1744133116000505.PubMedCrossRef

United Nations. Outcome document of the Third International Conference on Financing for Development: Addis Ababa Action Agenda. United Nations; 2015. http://www.un.org/ga/search/view_doc.asp?symbol=A/CONF.227/L.1 Accessed 30 June 2017.

Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis A, Degenhardt L, Dicker D, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386(9995):743–800. doi:10.1016/S0140-6736(15)60692-4.CrossRef

Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, Apfel H, Iannarone M, Phillips B, Lofgren KT, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9947):957–79. http://dx.doi.org/10.1016/S0140-6736(14)60497-9 PubMedPubMedCentralCrossRef

World Health Organization. Health systems financing: the path to universal coverage. 2010. http://apps.who.int/iris/bitstream/10665/44371/1/9789241564021_eng.pdf. Accessed 12 Mar 2017.

Preker AS, Carrin G. Health financing for poor people: resource mobilization and risk sharing. Washington, DC : World Bank; 2004. 446 p. Available from: http://www.getmed.co.sz/Health_financing_the_poor.pdf. Accessed 20 April 2017.

10.

Meessen B, Musango L, Kashala J-PI, Lemlin J. Reviewing institutions of rural health centres: the performance initiative in Butare, Rwanda. Trop Med Int Health TM IH. 2006;11(8):1303–17. doi:10.1111/j.1365-3156.2006.01680.x.PubMedCrossRef

11.

Soeters R, Habineza C, Peerenboom PB. Performance-based financing and changing the district health system: experience from Rwanda. Bull World Health Organ. 2006;84(11):884–9. PMCID: PMC2627555PubMedPubMedCentral

12.

Rusa L, Ngirabega J. De D, Janssen W, van Bastelaere S, Porignon D, Vandenbulcke W. Performance-based financing for better quality of services in Rwandan health centres: 3-year experience. Trop Med Int Health TM IH. 2009;14(7):830–7. doi:10.1111/j.1365-3156.2009.02292.x.PubMedCrossRef

13.

Eijkenaar F. Pay for performance in health care: an international overview of initiatives. Med Care Res Rev. 2012;69(3):251–76. doi:10.1177/1077558711432891.PubMedCrossRef

14.

Bonfrer I, Van de Poel E, Van Doorslaer E. The effects of performance incentives on the utilization and quality of maternal and child care in Burundi. Soc Sci Med. 2014;123:96–104. doi:10.1016/j.socscimed.2014.11.004.PubMedCrossRef

15.

Janssen W, Ngirabega J. De D, Matungwa M, van Bastelaere S. Improving quality through performance-based financing in district hospitals in Rwanda between 2006 and 2010: a 5-year experience. Trop Dr. 2015;45(1):27–35. doi:10.1177/0049475514554481.

16.

Manongi R, Mushi D, Kessy J, Salome S, Njau B. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider’s perspective in Rungwe Tanzania BMC Health Serv Res. 2014;14:154. doi:10.1186/1472-6963-14-154.PubMedCrossRef

17.

Ireland M, Paul E, Dujardin B. Can performance-based financing be used to reform health systems in developing countries? Bull World Health Organ. 2011;89(9):695–8. doi:10.2471/BLT.11.087379.PubMedPubMedCentralCrossRef

18.

Ssengooba F, McPake B, Palmer N. Why performance-based contracting failed in Uganda--an ‘open-box’ evaluation of a complex health system intervention. Soc Sci Med. 2012;75(2):377–83. doi:10.1016/j.socscimed.2012.02.050.PubMedCrossRef

19.

Fox S, Witter S, Wylde E, Mafuta E, Lievens T. Paying health workers for performance in a fragmented, fragile state: reflections from Katanga Province, Democratic Republic of Congo. Health Policy Plan. 2014;29(1):96–105. doi:10.1093/heapol/czs138.PubMedCrossRef

20.

Chimhutu V, Lindkvist I, Lange S. When incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania - a qualitative study. BMC Health Serv Res. 2014;14:23. doi:10.1186/1472-6963-14-23.PubMedPubMedCentralCrossRef

21.

Das A, Gopalan SS, Chandramohan D. Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review. BMC Public Health. 2016;16:321. doi:10.1186/s12889-016-2982-4.PubMedPubMedCentralCrossRef

22.

Princen S. Agenda-setting strategies in EU policy processes. J Eur Public Policy. 2011;18(7):927–43.CrossRef

23.

Shiffman J, Stanton C, Salazar AP. The emergence of political priority for safe motherhood in Honduras. Health Policy Plan. 2004;19(6):380–90. doi:10.1093/heapol/czh053.PubMedCrossRef

24.

Shiffman J. Generating political will for safe motherhood in Indonesia. Soc Sci Med 1982. 2003;56(6):1197–207. https://doi.org/10.1016/S0277-9536(02)00119-3.

25.

Green-Pedersen C, Wilkerson J. How agenda-setting attributes shape politics: basic dilemmas, problem attention and health politics developments in Denmark and the US. J Eur Public Policy. 2006;13(7):1039–52.CrossRef

26.

Koduah A, van Dijk H, Agyepong IA. The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Res Policy Syst. 2015;13:27. doi:10.1186/s12961-015-0016-9.PubMedPubMedCentralCrossRef

27.

Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan. 2008;23(5):294–307. doi:10.1093/heapol/czn019.PubMedPubMedCentralCrossRef

28.

Koduah A, van Dijk H, Agyepong IA. Technical analysis, contestation and politics in policy agenda setting and implementation: the rise and fall of primary care maternal services from Ghana’s capitation policy. BMC Health Serv Res. 2016;16:323. doi:10.1186/s12913-016-1576-2.PubMedPubMedCentralCrossRef

29.

Kingdon JW. Agendas, alternatives, and public policies, update edition, with an epilogue on health care. 2nd ed. Boston: Pearson; 2010. p. 304.

30.

Buse K, Mays N, Walt G. Making health policy. 2nd ed. Maidenhead, Berkshire, England. New York: Open University Press; 2012. p. 288.

31.

Mannheimer LN, Lehto J, Ostlin P. Window of opportunity for intersectoral health policy in Sweden--open, half-open or half-shut? Health Promot Int. 2007;22(4):307–15. doi:10.1093/heapro/dam028.PubMedCrossRef

32.

Agyepong IA, Adjei S. Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy Plan. 2008;23(2):150–60. doi:10.1093/heapol/czn002.PubMedCrossRef

33.

Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353–70.PubMedCrossRef

34.

Grindle MS, Thomas JW. Public choices and policy change: the political economy of reform in developing countries. 1st ed. Baltimore: Johns Hopkins University Press; 1991. p. 240.

35.

Paul E, Sossouhounto N, Eclou DS. Local stakeholders’ perceptions about the introduction of performance-based financing in Benin: a case study in two health districts. Int J Health Policy Manag. 2014;3(4):207–14. doi:10.15171/ijhpm.2014.93.PubMedPubMedCentralCrossRef

36.

Barnes A, Brown GW, Harman S, Papamichail A. African participation and partnership in performance-based financing: A case study in global health policy. EQUINET; 2014. http://www.equinetafrica.org/sites/default/files/uploads/documents/EQ%20GHD%20PBF%20Diss102.pdf. Accessed 15 Mar 2017.

37.

Chimhutu V, Tjomsland M, Songstad NG, Mrisho M, Moland KM. Introducing payment for performance in the health sector of Tanzania- the policy process. Glob Health. 2015;11:38. doi:10.1186/s12992-015-0125-9.CrossRef

38.

Kiendrébéogo JA, Shroff ZC, Berthé A, Yonli L, Béchir M, Meessen B. Why performance-based financing in Chad failed to emerge on the National Policy Agenda. Health Syst Reform. 2017;3(2):80–90.CrossRef

39.

Wong J. Healthy democracies: welfare politics in Taiwan and South Korea. Ithaca: Cornell University Press; 2006. p. 222.

40.

Lakin JM. The possibilities and limitations of insurgent technocratic reform: Mexico’s Popular Health Insurance program, 2001--2006. HARVARD UNIVERSITY; 2008. http://gradworks.umi.com/33/12/3312425.html. Accessed 29 Mar 2017.

41.

Keugoung B, Tsafack JP, Ymele Fouelifack F, Sieleunou I, Ayissi Noubosse I. Performance Based-Financing pilot project in the diocese of Batouri in Cameroon: lessons for the extension of the model. Antwerp: CoP PBF; 2011. http://www.healthfinancingafrica.org/uploads/8/0/8/8/8088846/pbf_cameroon_wp2__keugoung_et_al.pdf. Accessed 6 Mar 2017.

42.

Yin RK. Case study research: design and methods. 4th ed. Los Angeles: SAGE Publications, Inc; 2008. p. 240.

43.

Sabatier P, Jenkins-Smith HC. Policy change and learning: an advocacy coalition approach. Boulder: Westview Press; 1993.

44.

Ridde V. Olivier de Sardan J-P. Étudier les politiques publiques et les politiques de santé en Afrique de l’Ouest. Afr Contemp. 2013;243(3):98–9.CrossRef

45.

Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework. Health Policy Plan. 2014;29(Suppl 3):iii6–iii22. doi:10.1093/heapol/czu081.PubMedCrossRef

46.

Ridde V. ‘The problem of the worst-off is dealt with after all other issues’: the equity and health policy implementation gap in Burkina Faso. Soc Sci Med. 2008;66(6):1368–78. doi:10.1016/j.socscimed.2007.10.026.PubMedCrossRef

47.

Glenn A. Bowen. Document analysis as a qualitative research method. Qual Res J. 2009;9(2):27–40.CrossRef

48.

Creswell JW. Qualitative inquiry and research design: choosing among five traditions. 1st ed. Thousand Oaks: Sage Publications; 1998.

49.

Merriam SB. Case study research in education. 1st ed. San Francisco: Josey-Bass; 1991.

50.

Miles M, Huberman AM. Qualitative data analysis: an expanded sourcebook. Thousand Oaks: Sage Publications; 1994.

51.

AEDES. Performance based-financing implementation procedures manual. Bamenda: AEDES; 2012.

52.

Ministry of Public Health (MoPH). National Health Development Plan (NHDP 2011–2013). Yaounde: MoPH; 2011.

53.

Institut National de la Statistique. Enquête Démographique et de Santé. 2004. Yaounde: INS; 2005. http://www.dhsprogram.com/pubs/pdf/FR163/FR163-CM04.pdf. Accessed 11 Feb 2017.

54.

Ministry of Public Health (MoPH). Roadmap for the reduction of maternal and neonatal mortality in Cameroon 2006–2015. Yaounde: MoPH. p. 2005. http://www.afro.who.int/publications/roadmap-reduction-maternal-and-neonatal-mortality-cameroon-2006-2015. Accessed 25 Feb 2017.

55.

UNFPA. Why invest in reproductive health in Cameroon? 2012. Yaounde: UNFPA; 2012. http://esaro.unfpa.org/publications/why-invest-reproductive-health-cameroon. Accessed 13 Mar 2017

56.

The World Bank. Cameroon country status report: reversing the decline in health outcomes. Washington DC: WB; 2003.

57.

Transparency International. Corruption perceptions index. http://www.transparency.org/research/cpi/overview. Accessed 6 Jan 2017.

58.

National Anti-Corruption Commission (NACC). Report on the state of the fight against corruption in Cameroon. Yaounde: NACC; 2011. https://www.acauthorities.org/sites/aca/files/countrydoc/Introduction%20Generale.pdf. Accessed 30 Jan 2017.

59.

The World Bank. World bank report no: PAD923. International development association project paper on a proposed additional funds. Washington DC: WB; 2014. http://documents.worldbank.org/curated/en/366061468233037178/pdf/PAD9230PJPR0P1010Box385226B00OUO090.pdf. Accessed 21 Feb 2017.

60.

Boulenger D, Criel B. The difficult relationship between faith-based health care organisations and the public sector in sub-Saharan Africa the case of contracting experiences in Cameroon, Tanzania, Chad and Uganda. Antwerp: ITG Press; 2012. http://www.medicusmundi.org/en/contributions/reports/2012/the-difficult-relationship-between-faith-based-health-care-organisations-and-the-public-sector-in-sub-saharan-africa/2012-itm-mmi-boek-final.pdf. Accessed 2 Apr 2017

61.

Sieleunou I, Turcotte-Tremblay A-M, Yumo HA, Kouokam E, Fotso J-CT, Tamga DM, Ridde V. Transferring the purchasing role from international to National Organizations during the scale-up phase of performance-based financing in Cameroon. Health Syst Reform. 2017;3(2):91–104.CrossRef

62.

Meessen B, Hercot D, Noirhomme M, Ridde V, Tibouti A, Tashobya CK, et al. Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries. Health Policy Plan. 2011;26(suppl 2):ii16–29. doi:10.1093/heapol/czr062.PubMed

63.

Crawford G. Partnership or power? Deconstructing the ‘Partnership for Governance Reform’ in Indonesia. Third World Q. 2003;24(1):139–59.CrossRef

64.

Beland D, Orenstein MA. International organizations as policy actors: an ideational approach. Glob Soc Policy. 2013;13(2):125–43. doi:10.1177/1468018113484608.CrossRef

65.

Shiffman J. Generating political priority for maternal mortality reduction in 5 developing countries. Am J Public Health. 2007;97(5):796–803. doi:10.2105/AJPH.2006.095455.PubMedPubMedCentralCrossRef

66.

Diaz Pedregal V, Destremau B, Criel B. Health policy in Cambodia: to what extent is an aid-dependent country able to determine its own policy? J Soc Policy. 2015;44(01):171–87. doi:10.1017/S0047279414000543.CrossRef

67.

Lapping K, Frongillo EA, Studdert LJ, Menon P, Coates J, Webb P. Prospective analysis of the development of the national nutrition agenda in Vietnam from 2006 to 2008. Health Policy Plan. 2012;27(1):32–41. doi:10.1093/heapol/czr013.PubMedCrossRef

68.

Anderson E. Experts, ideas, and policy change: the Russell Sage Foundation and small loan reform, 1909–1941. Theory Soc. 2008;37(3):271–310.CrossRef

69.

Parkhurst JO, Vulimiri M. Cervical cancer and the global health agenda: insights from multiple policy-analysis frameworks. Glob Public Health. 2013;8(10):1093–108. doi:10.1080/17441692.2013.850524.PubMedPubMedCentralCrossRef

70.

Robert E, Ridde V. Global health actors no longer in favor of user fees: a documentary study. Glob Health. 2013;9:29. doi:10.1186/1744-8603-9-29.CrossRef

71.

Béland D. Ideas, institutions, and policy change. J Eur Public Policy. 2009;16(5):701–18. doi:10.1080/13501760902983382.CrossRef

72.

Kay A. Understanding policy change as a hermeneutic problem. J Comp Policy Anal Res Pract. 2009;11(1):47–63.CrossRef

73.

Zittoun P. Understanding policy change as a discursive problem. J Comp Policy Anal Res Pract. 2009;11(1):65–82.CrossRef

74.

Schmidt VA. Does discourse matter in the politics of welfare state adjustment? Comp Polit Stud. 35:168–93.

75.

Blyth M. The transformation of the Swedish model: economic ideas, distributional conflict, and institutional change. World Polit. 2001;54(1):1–26.CrossRef

76.

The World Bank. From crisis to sustainable growth - sub Saharan Africa : a long-term perspective study. Report no.: 8209. Washington DC: The World Bank; 1989. http://documents.worldbank.org/curated/en/498241468742846138/From-crisis-to-sustainable-growth-sub-Saharan-Africa-a-long-term-perspective-study. Accessed 17 Feb 2017

77.

Mkandawire T. ‘Good governance’: the itinerary of an idea. Dev Pract. 2007;17(4–5):679–81.CrossRef

78.

Sieleunou I, Taptue JC, Kouokam Magne E, Tamgang D, Yumo H, Turcotte-Tremblay A-M, et al. Challenges of integrating an innovative health financing scheme into the health system: lessons from performance-based-financing (PBF) in Cameroon (2006–2015). R4D International: Yaounde; 2015.

79.

Soeters R. Performance based financing : theory and instruments. The Hague: SINA Health; 2016. http://www.sina-health.com/wp-content/uploads/LivrePBFSantEducSINATh%C3%A9orieMeilPratV200516.pdf. Accessed 10 Mar 2017.

80.

Munira SL, Fritzen SA. What influences government adoption of vaccines in developing countries? A policy process analysis. Soc Sci Med 1982. 2007;65(8):1751–64. https://doi.org/10.1016/j.socscimed.2007.05.054.

81.

Tantivess S, Walt G. The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand. Health Policy Plan. 2008;23(5):328–38. doi:10.1093/heapol/czn023.PubMedCrossRef

82.

World Health Organization, UNICEF, United Nations, Department of Economic and Social Affairs, Population Division, World Bank. Trends in maternal mortality: 1990 to 2015 : estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division. Geneva: WHO; 2015. http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/. Accessed 10 Jan 2017.

83.

United Nations Economics Commission for Africa, Union A, African Development Bank. United Nations Development Programme. MDG Report 2015: Assessing progress in Africa toward the millennium development goals. Addis Ababa: Economic Commission for Africa; 2015. http://www.undp.org/content/undp/en/home/librarypage/mdg/mdg-reports/africa-collection.html. Accessed 10 Jan 2017.

84.

Erasmus E, Gilson L. How to start thinking about investigating power in the organizational settings of policy implementation. Health Policy Plan. 2008;23(5):361–8. doi:10.1093/heapol/czn021.PubMedCrossRef

85.

Sabatier PA, Weible CM. Theories of the policy process. 3rd ed. Boulder: Westview Press; 2014. p. 432.

86.

Sabatier PA. Policy change and learning: an advocacy coalition approach. Jenkins-smith HC. Boulder: Westview Press; 1993. p. 304.

87.

Shroff ZC, Roberts MJ, Reich MR. Agenda setting and policy adoption of India’s National Health Insurance Scheme: Rashtriya Swasthya Bima Yojana. Health Syst Reform. 2015;1(2):107–18. http://dx.doi.org/10.1080/23288604.2015.1034310.CrossRef

88.

Béland D. Policy change and health care research. J Health Polit Policy Law. 2010;35(4):615–41. doi:10.1215/03616878-2010-019.PubMedCrossRef

89.

Campbell AL. Policy feedbacks and the impact of policy designs on public opinion. J Health Polit Policy Law. 2011;36(6):961–73. doi:10.1215/03616878-1460542.PubMedCrossRef

90.

Pisani E, Olivier Kok M, Nugroho K. Indonesia’s road to universal health coverage: a political journey. Health Policy Plan. 2017;32(2):267–76. doi:10.1093/heapol/czw120.PubMed

91.

Eldridge C, Palmer N. Performance-based payment: some reflections on the discourse, evidence and unanswered questions. Health Policy Plan. 2009;24(3):160–6. doi:10.1093/heapol/czp002.PubMedCrossRef

92.

Birkland TA. After disaster: agenda setting, public policy, and focusing events. Washington DC: Georgetown University Press; 1997. p. 178.

93.

Hemsley-Brown J, Sharp C. The use of research to improve professional practice: a systematic review of the literature. Oxf Rev Educ. 2003;29(4):449–71.CrossRef

94.

Bowen S, Zwi AB. Pathways to ‘evidence-informed’ policy and practice: a framework for action. PLoS Med. 2005;2(7):e166. doi:10.1371/journal.pmed.0020166.PubMedPubMedCentralCrossRef

95.

Willis B. The Advantages and Limitations of Single Case Study Analysis. E-International Relations; 2014. http://www.e-ir.info/2014/07/05/the-advantages-and-limitations-of-single-case-study-analysis/. Accessed 30 Jan 2017.

96.

Zida A, Lavis JN, Sewankambo NK, Kouyate B, Moat K, Shearer J. Analysis of the policymaking process in Burkina Faso’s health sector: case studies of the creation of two health system support units. Health Res Policy Syst. 2017;15:10. doi:10.1186/s12961-017-0173-0.PubMedPubMedCentralCrossRef

Title: Setting performance-based financing in the health sector agenda: a case study in Cameroon
Authors: Isidore Sieleunou
Anne-Marie Turcotte-Tremblay
Jean-Claude Taptué Fotso
Denise Magne Tamga
Habakkuk Azinyui Yumo
Estelle Kouokam
Valery Ridde
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Globalization and Health / Issue 1/2017
Electronic ISSN: 1744-8603
DOI: https://doi.org/10.1186/s12992-017-0278-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Setting performance-based financing in the health sector agenda: a case study in Cameroon

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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