title: Community participation and voice mechanisms under performance-based financing schemes in Burundi.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of International Development, University of Oxford, Oxford, UK. jean-benoit.falisse@qeh.ox.ac.uk
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Falisse
authors.forename: Bruno
authors.initials: B
authors.lastname: Meessen
authors.forename: Juvénal
authors.initials: J
authors.lastname: Ndayishimiye
authors.forename: Michel
authors.initials: M
authors.lastname: Bossuyt
mesh_terms: D002063:Burundi; D003142:Communication; D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D018672:Community Health Planning / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003256:Community Participation / Q000379:methods* / Q000706:statistics & numerical data; D003159:Community-Institutional Relations / Q000191:economics; D003906:Developing Countries; D005260:Female; D005381:Financing, Organized / Q000458:organization & administration*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011634:Public Health / Q000191:economics / Q000379:methods / Q000592:standards; D012423:Rural Health; D012424:Rural Population