title: Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.
abstract: BACKGROUND
  The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications.
  
  
  METHODS
  The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods.
  
  
  CONCLUSIONS
  Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.
authors.affiliation: University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada. valery.ridde@umontreal.ca.|University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada. valery.ridde@umontreal.ca.
authors.forename: Valéry
authors.initials: V
authors.lastname: Ridde
authors.affiliation: University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada. anne-marie.turcotte-tremblay@umontreal.ca.|University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada. anne-marie.turcotte-tremblay@umontreal.ca.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Turcotte-Tremblay
authors.affiliation: Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. souares@uni-heidelberg.de.
authors.forename: Aurélia
authors.initials: A
authors.lastname: Souares
authors.affiliation: Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. julia.lohmann@uni-heidelberg.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Lohmann
authors.affiliation: University of Montreal Hospital Research Center (CRCHUM), 850 Saint-Denis, 3rd Floor, Montréal, QC, H2X 0A9, Canada. david.zombre@umontreal.ca.|University of Montreal School of Public Health, 7101 Avenue du Parc, 3rd Floor, Montréal, QC H3N 1X9, Canada. david.zombre@umontreal.ca.
authors.forename: David
authors.initials: D
authors.lastname: Zombré
authors.affiliation: Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. jlkoulidiati@gmail.com.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Koulidiati
authors.affiliation: AFRICSanté & Université Catholique de l'Afrique de l'Ouest - Unité Universitaire de Bobo-Dioulasso, 01 BP 298, Bobo-Dioulasso, Burkina Faso. yaogo@hotmail.com.
authors.forename: Maurice
authors.initials: M
authors.lastname: Yaogo
authors.affiliation: Centre MURAZ, 01 BP, Bobo-Dioulasso, Burkina Faso. hien_herve@hotmail.com.|Institut de recherche en sciences de la santé (IRSS) du CNRST, 03 BP 7192 03, Ouagadougou, Burkina Faso. hien_herve@hotmail.com.
authors.forename: Hervé
authors.initials: H
authors.lastname: Hien
authors.affiliation: School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, 2nd Floor, Montréal, QC H3G 1Y5, Canada. matthew.hunt@mcgill.ca.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hunt
authors.affiliation: Institut des Sciences des Sociétés (INSS-CNRST), 03 BP 7047, Ouagadougou, Burkina Faso. zongsyl@yahoo.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Zongo
authors.affiliation: Institute of Public Health, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany. manuela.de.allegri@urz.uni-heidelberg.de.
authors.forename: Manuela
authors.initials: M
authors.lastname: De Allegri
mesh_terms: D002050:Burkina Faso; D006297:Health Services Accessibility / Q000191:economics*; D061889:Healthcare Financing; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008137:Longitudinal Studies; D015397:Program Evaluation; D019472:Universal Health Insurance / Q000191:economics*