Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda

Joel Arthur Kiendrebeogo, Zubin Cyrus Shroff, Abdramane Berthe, Lamoudi Yonli, Mahamat Bechir, Bruno Meessen

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


    Supported by the World Bank (WB), Chad implemented a performance-based financing (PBF) scheme as a pilot, from October 2011 to May 2013. However, despite promising results and the government's stated commitment to ensure its continuation after the World Bank's departure, PBF failed to come onto the national policy agenda. This article aims to explain why this was the case, an especially interesting question given that several factors were favorable for project continuation. Data for this case study were collected through literature review and key informant interviews. We applied Kingdon's agenda setting theory to explain this failure. We found that though the potential of PBF to address challenges facing the Chadian health system was confirmed by internal and external evaluations of the pilot, it failed to move from the governmental agenda to the decision agenda. The main reason was a lack of dedicated policy entrepreneurs, resulting in a weak actual ownership of the policy by national authorities and key stakeholders. We tried to understand why such policy entrepreneurs failed to emerge.

    Original languageEnglish
    JournalHealth Systems & Reform
    Issue number2
    Pages (from-to)80-90
    Number of pages11
    Publication statusPublished - 2017


    • Africa
    • agenda setting
    • Chad
    • Kingdon
    • multiple streams approach
    • performance-based financing
    • pilot
    • policy analysis
    • policy nonemergence
    • HEALTH
    • STATE

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