Community participation and voice mechanisms under performance-based financing schemes in Burundi

J.B. Falisse, B. Meessen, J. Ndayishimiye, M. Bossuyt

Research output: Contribution to journalA1: Web of Science-articlepeer-review


Objective Community participation is often described as a key for primary health care in low-income countries. Recent performance-based financing (PBF) initiatives have renewed the interest in this strategy by questioning the accountability of those in charge at the health centre (HC) level. We analyse the place of two downward accountability mechanisms in a PBF scheme: health committees elected among the communities and community-based organizations (CBOs) contracted as verifiers of health facilities' performance. Method We evaluated 100 health committees and 79 CBOs using original data collected in six Burundi provinces (2009-2010) and a framework based on the literature on community participation in health and New Institutional Economics. Results Health committees appear to be rather ineffective, focusing on supporting the medical staff and not on representing the population. CBOs do convey information about the concerns of the population to the health authorities; yet, they represent only a few users and lack the ability to force changes. PBF does not automatically imply more 'voice' from the population, but introduces an interesting complement to health committees with CBOs. However, important efforts remain necessary to make both mechanisms work. More experiments and analysis are needed to develop truly efficient 'downward' mechanisms of accountability at the HC level.
Original languageEnglish
JournalTropical Medicine and International Health
Issue number5
Pages (from-to)674-682
Number of pages9
Publication statusPublished - 2012


  • Health systems
  • Primary health care
  • Health financing
  • Health care financing
  • Performance-based payment
  • National policies
  • Evaluation
  • Accountability
  • Health committees
  • Community health services
  • Community-based care
  • Leadership
  • Organization
  • Performance
  • Effectiveness
  • Rural
  • Burundi
  • Africa-Central


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