Suchergebnisse

Le financement basé sur les résultats (FBR) dans le secteur de la santé est un modèle voyageur. En dépit de premiers écrits positifs, les preuves de son efficacité se sont érodées. En 2018, un article critique du FBR a suscité des réactions individuelles et collectives parfois virulentes. Nous analysons cette controverse à l'aide d'une analyse qualitative de ces discours. Il en ressort qu'aucun questionnement fondamental de l'approche du FBR n'est proposé par ses promoteurs, qui ne remettent pas en cause le fondement de leur modèle, mais son voyage. Cette controverse illustre l'importance des acteurs et de leurs réseaux dans la construction sociale de la réputation d'un modèle voyageur. Une fois forgée – même sans preuve –, il est difficile de la remettre en question. ; Results-based financing (RBF) in the healthcare sector is a travelling model. Despite early positive findings, evidence of its effectiveness has been scarce. In 2018, an article that was critical of RBF caused individual and collective reactions that were virulent at times. We analyze this controversy using qualitative discourse analysis. We find that neither the RBF approach nor its basis was fundamentally questioned, but only its journey was. This controversy illustrates the importance of actors and their networks in the social construction of the reputation of a travelling model. Once forged – even without proof – it is difficult to question it. ; info:eu-repo/semantics/published

Context: Deficient HRH management – especially insufficient training and motivation, and adverse distribution of qualified staff countrywide, at the expense of poor and remote areas – has been identified for over a decade as one major constraint for the implementation of Mali's national health policy. Main objective: The HRH policy aims to define a coherent framework for the ministry of health (MoH) and its partners in order to ensure the harmonious development, distribution, management and motivation of health staff so as to ultimately improve health results. The policy is translated into an operational plan dealing specifically with training, recruitment, motivation, and career management. Methodology: The HRH policy and plan were developed by a core team under the leadership of the Planning Department of the MoH, with the involvement from other departments of the MoH, the ministries in charge of finance (MoF) and civil service (MoCS), and donors. After analyzing existing studies and data, the diagnosis over the major problems to be tackled was done. This allowed identifying the main orientations of the policy, which were then translated into strategies and interventions, and then costed. Once the policy and plan have been drafted by the core team, they have been circulated to all departments and partners and discussed in several meetings with different stakeholders at central level. After integrating comments from these meetings, the MoH organized a validation workshop with very broad participation (including the operational level, private sector, and civil society) so as to ensure ownership. Final amendments were negotiated with the MoF and MoCS in order to be adopted as a national policy by the Counsel of Ministers by the end of 2009. Results: The HRH policy and plan now benefit from wide political support by major stakeholders. Yet, implementation still has been delayed because of the management modalities at operational level still need to be definitively agreed upon. Conclusion: The inclusive development ...

Context: Deficient HRH management – especially insufficient training and motivation, and adverse distribution of qualified staff countrywide, at the expense of poor and remote areas – has been identified for over a decade as one major constraint for the implementation of Mali's national health policy. Main objective: The HRH policy aims to define a coherent framework for the ministry of health (MoH) and its partners in order to ensure the harmonious development, distribution, management and motivation of health staff so as to ultimately improve health results. The policy is translated into an operational plan dealing specifically with training, recruitment, motivation, and career management. Methodology: The HRH policy and plan were developed by a core team under the leadership of the Planning Department of the MoH, with the involvement from other departments of the MoH, the ministries in charge of finance (MoF) and civil service (MoCS), and donors. After analyzing existing studies and data, the diagnosis over the major problems to be tackled was done. This allowed identifying the main orientations of the policy, which were then translated into strategies and interventions, and then costed. Once the policy and plan have been drafted by the core team, they have been circulated to all departments and partners and discussed in several meetings with different stakeholders at central level. After integrating comments from these meetings, the MoH organized a validation workshop with very broad participation (including the operational level, private sector, and civil society) so as to ensure ownership. Final amendments were negotiated with the MoF and MoCS in order to be adopted as a national policy by the Counsel of Ministers by the end of 2009. Results: The HRH policy and plan now benefit from wide political support by major stakeholders. Yet, implementation still has been delayed because of the management modalities at operational level still need to be definitively agreed upon. Conclusion: The inclusive development process has been necessary to move on with the complex and highly sensitive issue of HRH management, and to get the support from MoF, MoSC and donors who are supposed to contribute to its financing. ; Peer reviewed

A well-functioning public expenditure management system (PEM) is considered a critical pillar of government efficiency. This article discusses PEM systems in developing countries using an analytical framework based on principal-agent theory. This simple model can be applied to various PEM systems and allows for comparisons between institutional settings. To illustrate this, the authors analyse the benefits derived from the use by the ministry of finance of ex post audits and ex ante controls, and assess their value in terms of their ability to deter cheating. The authors derive a set of possible "control regimes" which can be used by the ministry of finance. ; info:eu-repo/semantics/published

A well-functioning public expenditure management system (PEM) is considered a critical pillar of government efficiency. This article discusses PEM systems in developing countries using an analytical framework based on principal-agent theory. This simple model can be applied to various PEM systems and allows for comparisons between institutional settings. To illustrate this, the authors analyse the benefits derived from the use by the ministry of finance of ex post audits and ex ante controls, and assess their value in terms of their ability to deter cheating. The authors derive a set of possible "control regimes" which can be used by the ministry of finance. ; Peer reviewed

A well-functioning public expenditure management (PEM) system is considered a critical pillar of government efficiency, on par with a low-distortion tax system and efficient tax administration. The paper discusses PEM systems in developing countries using an analytical framework based on principal-agent theory. This simple model can be applied to various PEM systems, and allows for comparisons between institutional settings. To illustrate this, we analyze the benefits derived from the use by the Ministry of Finance (MoF) of two control instruments; ex post audits and ex ante controls, and assess their value in terms of their ability to deter cheating. We derive a set of possible "control regimes" which can be used by the MoF. Although we illustrate the use of the model using developing countries, it is also relevant to developed economies. ; Peer reviewed

Le groupe de recherche sur les instruments de coopération en appui aux politiques sectorielles (GRAP-SWAP) est financé pendant quatre ans (2004-2008) par la Coopération belge pour mener des recherches et l'éclairer dans ses choix concernant l'approche sectorielle (en particulier dans le domaine de la santé) et l'appui budgétaire. Il réunit trois équipes : les Écoles de Santé publique de l'UCL et de l'ULB, ainsi que le service d'Économie politique et Finances publiques de l'ULg. Le Rwanda fait partie, avec le Bénin et le Mali, des pays-cibles du GRAP-SWAP. Contrairement aux autres pays qui sont davantage l'objet d'observations, différentes opportunités font du Rwanda un terrain propice à une recherche-action. En effet, l'approche sectorielle n'y est encore que naissante, la Belgique est leader du Cluster Santé et souhaite développer « empiriquement » des outils innovants ; en outre, certains membres du GRAP-SWAP ont noué des relations de confiance avec les partenaires rwandais, notamment au Ministère de la Santé (MINISANTE) et à l'Ecole de Santé publique (ESP). L'approche sectorielle Santé au Rwanda fera l'objet d'une recherche sur plusieurs années par le GRAP-SWAP. Cette première mission a été menée par Elisabeth Paul du 13 au 24 septembre 2005, accompagnant une mission du Dr Denis Porignon1 , coordinateur du groupe et possédant une longue expérience dans le pays. Elle visait trois objectifs : - établir un premier contact avec les acteurs et partenaires de la santé au Rwanda en leur présentant les travaux du GRAP-SWAP ; - identifier des questions de recherche-action à investiguer par la suite ; - « briefer » l'équipe de recherche locale (ESP, représentée par son Directeur, le Dr Laurent Musango) sur les actions à réaliser et les données à collecter

This paper analyzes the pervasiveness and persistence of rent seeking, misgovernance, and public sector inefficiency in many developing and transition economies. We formalize evidence from country experiences and empirical studies into a stylized analytical framework that reflects realistic constraints faced in these countries. Our work departs from the standard economic literature by assuming that (i) the relationship between the government and its population is regulated through an implicit social consensus; (ii) traditional incentives (in the form of public expenditure controls, sanctions, or monetary incentives to perform) are, for various reasons, ineffective in many of these countries; and (iii) the persistence of high corruption reflects a very stable equilibrium, which in turn reflects the fact that several constraints are simultaneously binding. We argue that, when traditional incentives fail, transparency—information provision and disclosure, together with the means to use it—by relaxing different constraints, can contribute to improving public outcomes. ; info:eu-repo/semantics/published

This paper analyzes the pervasiveness and persistence of rent seeking, misgovernance, and public sector inefficiency in many developing and transition economies. We formalize evidence from country experiences and empirical studies into a stylized analytical framework that reflects realistic constraints faced in these countries. Our work departs from the standard economic literature by assuming that (i) the relationship between the government and its population is regulated through an implicit social consensus; (ii) traditional incentives (in the form of public expenditure controls, sanctions, or monetary incentives to perform) are, for various reasons, ineffective in many of these countries; and (iii) the persistence of high corruption reflects a very stable equilibrium, which in turn reflects the fact that several constraints are simultaneously binding. We argue that, when traditional incentives fail, transparency—information provision and disclosure, together with the means to use it—by relaxing different constraints, can contribute to improving public outcomes. ; Peer reviewed