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L’aide au développement et le financement basé sur la performance : quelle performativité ? : analyse du processus de conceptualisation et de diffusion du financement basé sur la performance dans la gestion des systèmes de santé africains par la Banque Mondiale et l’USAID : étude du cas du Programme national de financement basé sur les résultats du Ministère de la Santé du Sénégal

Abstract : Performance-based financing is a management approach promoted by the World Bank (WB) and the United States Agency for International Development (USAID) that is rapidly being mainstreamed in development assistance programs. In a context where many studies have demonstrated the subjectivity of the link between the fight against poverty and the "good policies" recommended by the WB in the context of performance-based allocation (or selectivity), it seems relevant to question the performativity of this new instrument. Drawing jointly on actor-network theory and neo-institutional theories, we analyze the process of designing, experimenting, disseminating and implementing the instrument in the field of health policy reforms at the global level and then at the national level.At the global level, we study the conceptualization of the instrument, which we place in agenealogy of the neoliberal network's performance of development aid and global healthcarepolicies. We then analyze its experimentation in Rwanda, as part of a market-based regulationfor healthcare systems implemented through: (I) the deployment of activity-based payments to transform healthcare structures into autonomous economic actors (on the supply side), and (II) the creation of private community-based insurance structures designed to develop purchasing strategies (on the demand side). Finally, we study the instrument’s institutional diffusion under the effects of (I) a promotion of the Rwandan experiment decontextualized from the country’sspecific political situation, and (II) an incentive mechanism allowing the enrolment of both WB’sofficials and the ministries that are benefitting from the WB’s aid. At the national level, we have studied the influence strategy of a coalition of actors composedof the WB and USAID to promote the dissemination of these reforms in Senegal. We present the process of adoption of the reforms by the Ministry of Health, the failure of a competing regulatory model that was being tested by Belgian technical cooperation, and then the pressure exerted by the WB to coerce the government into internalizing the promoted model.We then put into perspective the abandonment of the market-based regulatory model that was initially announced, in favor of a new transnational regulation, materialized by activity-basedfinancing contracts that are directly controlled by the WB.
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Jean-Hugues Caffin. L’aide au développement et le financement basé sur la performance : quelle performativité ? : analyse du processus de conceptualisation et de diffusion du financement basé sur la performance dans la gestion des systèmes de santé africains par la Banque Mondiale et l’USAID : étude du cas du Programme national de financement basé sur les résultats du Ministère de la Santé du Sénégal. Gestion et management. Université Panthéon-Sorbonne - Paris I, 2018. Français. ⟨NNT : 2018PA01E037⟩. ⟨tel-02336956⟩

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