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Table 5 DEs’ representation of the problems (based on definitions extracted from [23,24,25,26,27])

From: How is the discourse of performance-based financing shaped at the global level? A poststructural analysis

Represented problems that PBF intends to solve Related quotes
1. Input-based financing systems with passive strategic function causing public service ineffectiveness and inefficiency) Let’s no longer speak about how many health facilities are being built, how many staffs are being trained […]. Because [ministries of finance in LMICs] have been putting a lot of money into... into input-based financing for a long time and not necessarily seen results thereafter. (I03_INTORG)
2. Lack of accountability of public health spending You cannot ask somebody to manage something like… two billions, three billions as incomes… to put that in a system; and believe that he will do that… properly… No! He must live… And… He injects the 2 billions… without earning anything from those 2 billions. Well: I do not think that in… in-in-in other… in any other country this can work out, when you know that he gets paid 200,000 francs. What do… What do you expect? (laughs). While if… based on his efficacy to inject the two billions in the health system, there was something… formal, clear… [that enabled him to keep some money for himself] I am sure he would… he would be eager to do his job properly. (I49_NATGOV)
3. Unmotivated and underperforming health workers In most African countries, people... people are not... well paid. I think that... with the salaries that people... the remuneration must get to a fair value. And... in... in this [PBF] system, it's well-known: if you work better, you’ll get more bonuses. So your work is recognised in value. (I41_NATGOV)
4. Highly centralised decision-making (i.e., for health planning and management) A big problem in [African] countries that I’ve seen… is that they are all centralised: you want something, you have to go to the ministry of health, and talk to the director… of procurement, et cetera… to get a status quo. For me, I think it's scandalous; we must stop, we must completely change. (I33_INTORG)
5. Underperforming monitoring systems I think information and transparency is something that’s extremely important. Hum… Again, taking a context like [country name removed] where there is no health information system, it just doesn’t exist: they’ve tried a thousand times, through a dozen of different ways, and it just never gets up and running. (I08_INTORG)