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 of performance-based financing (PBF) in Africa has focused research attention on its effects regarding improving the health care system or achieving health-related Millennium Development Goals (MDGs). Similarly, critics of PBF have concentrated more on its inability to transform structural indicators of the health system positively and sustainably. So far, the scientific literature has not sufficiently explored the implications concerning the ideological and operational mutations that the PBF is operating. This study investigates these aspects of PBF in conception and operationalization of public health intervention.The concept of depoliticization of public health action is proposed in this analysis to describe the capacity of the PBF to redraw health policy from the realm of political and State intervention, and from the primacy of public sector to field of market-based competition between Government sponsored and non-State actors.