LIST OF PANELS

Co-organized with Dr. Nick Turnbull (University of Manchester)

GENERAL OBJECTIVES: The objective of this panel is to discuss studies applying Public Policy theories and related theories and concepts in Health System Research to study the design/formulation and/or implementation processes of pay for performance programs (P4P) – also known as performance-based financing (PBF) - in health policy in high-, middle- and low-income countries, focused either on theoretical or empirical approaches, as case or comparative study.

RESEARCH QUESTIONS: In what ways diverse Public Policy elements/ aspects/ dynamics/ processes related to policy (re)design/(re)formulation and implementation of P4P/PBF programs can affect health system performance and/or building blocks in countries adopting varied models of primary health care (PHC), which are at distinct stages of development? What are the main actors involved in policy (re)design/ (re)formulation? How international organizations, national policymakers and stakeholders, policy brokers, entrepreneurs (diffusion), and consultants have influenced the policy-making process? What types of policy learning and policy feedback have been taking place at both the design/ formulation and implementation levels? To what extent policy (re)design/ (re)formulation have taken into consideration implementation failures and involved national/local government actors, communities of knowledge and front-line health workers? What are the main policy and performance drivers/mechanisms that have characterized the implementation of P4P/PBF and how differently or commonly have they impacted health systems in high-, middle- and low-income countries? How motivations, behaviours and discretionary decisions/power have varied in contexts with distinct organizational capacities, in different stages of development of a culture of monitoring and evaluation at both the policy-making and implementation levels? If/how unintended consequences or political paradoxes such as gaming, cheating and spillover effects have characterized those processes?

SCIENTIFIC RELEVANCE:

Public Policy theories and analysis are relevant to uncover the policy and political dynamics of (re)design/ (re)formulation and implementation processes of rational-based programs such as P4P/PBF. This is because Public Policy offers some key concepts and methods/approaches for understanding why/how different and similar policy and political processes affects health systems performance and/or building blocks. However, and despite the spread of P4P/PBF on the globe, Public Policy theories and analytical approaches have been little (or practically not) employed in the analyses of P4P/PBF in various countries and comparatively (especially). In general, studies tend to focus mainly, albeit differently, on outcome analyses. In high-, middle-, and low-income countries, there are few (or no) publications focusing on the design/formulation of pay for performance programs, so that we do not analytically and in a systematized way know how the design / formulation of P4P/PBF varies and can be compared within different contexts and models of PHC. As far as the implementation process is concerned, there is still a research gap and especially (but not only) in high- and middle-income countries. In low-income countries adopting PBF, and despite the diversity of methods and types of qualitative and system analysis, elements / concepts of Public Policy have been privileged by few studies.

P4P/PBF programs have been interrupted in countries such as Scotland, Mali and Mozambique, and presents a risk of discontinuity in others (as in England). Its continuity in countries like Brazil and scale-up in Zimbabwe occurs at a time where there is still a gap in comparative knowledge from other cases considered both as success and failures cases. We argue that the non- or low-use of Public Policy theories delays this process of learning/ transference of comparative knowledge. Public Policy could contribute to speed-up, in a comprehensive way, the opening of the so-called "black box" of P4P/PBF, highlighting how policy drivers or mechanisms could, in an inter-related way, contribute (or not) to the sustainable development or scale-up of P4P/PBF.

We are calling researchers, policymakers, practitioners and policy experts from high-, middle- and low-income countries to propose papers on pay for performance programs (P4P/PBF) to this panel: “Public Policy and Pay for Performance Programs in health: in High-, Middle- and Low-income countries”. We welcome papers applying Public Policy theories and related (or complementary) theories and concepts/frameworks in Health System Research to study the design/formulation and/or implementation processes of pay for performance programs (P4P) and performance-based financing (PBF) in health policy in high-, middle- and low-income countries, focused either on theoretical or empirical approaches, as case or comparative study. Analyses should focus on actors, ideas and interests involved in the policy-making and/or implementation, as well as on the characteristics of the institutions involved. Moreover, political contexts and level of economic development should be considered in the analysis. We expect papers to take into account the main theories and concepts (or one or few of them) used by Public Policy in the analyses of policy design/formulation and implementation, such as: social learning, types of policy learning, policy feedback, policy transfer, policy brokers, policy entrepreneurship, policy consultancies, networks or communities, street level bureaucracy or front-line actors, policy transfer or diffusion, as examples. Papers that gather original data/text from surveys, interviews, focus groups, observations, forms of participation are highly encouraged. Studies comparing those interventions where the medical intervention and professional practice has only a partial effect and where self-care and informal care may play a larger role in success are welcome as well. Analyses focusing on the state of the debate and going beyond the polarized debated about PBF in global health, and by means of analysing other broader contextual aspects and from a multidisciplinary perspective are welcome as well. Thematic analysis, documentary analyses, critical reviews, literature reviews and qualitative evidence syntheses analyses employing Public Policy concepts or analytical approaches will be considered as well. Framework analysis, causal inference case studies, process tracing analyses, multi methods, mixed methods and long- term process and longitudinal analyses and comparisons across countries will be highly appreciated.

We will give priority to papers that bring out new findings/contextual evidences to the field due to the employment of Public Policy theories and analytical approaches, but are happy to receive papers that present policy and system themes/ perspectives in any creative or innovative policy relevant ways.

Policymakers, researchers and practitioners will benefit from this proposed panel and discussions. Considering, for instance, that PBF has been developed mainly (or concentrated) in African countries, and that their experiences and discussions/debates have been taking place separately from high- and some middle-income countries (especially from Latin American middle-income countries [and also low-income countries in the Americas]), actors involved with PBF in Africa and Asia or in global networks or communities of practices will have the opportunity to share and discuss their knowledge/experience with and learn from experts/studies focused on high- and middle-income countries in other parts of the globe. High- and middle-income countries will be able to learn how community-based models in primary care have been developing PBF, bring broader and singular lessons to their studies/policy process. All actors will have the opportunity to identify similarities and differences that will strengthen their knowledge regarding what types of policy initiatives/drivers/mechanisms are more effective (or hold middle or low levels of effectiveness) when designing/formulating and implementing diverse but similar types of pay for performance programs.

In this panel a selection of papers may be considered for the publication we intend to organize.