The diffusion of managerial practices in performance perspective: a review of transfer models in health systems

Richard Ndayishimiye, Dominique Niyondiko, Abel Bazira Bigawa


Managerial practices are widely held to be a vital component of efficient organizations, especially in public services where they are being transferred for the last decades. From a performance perspective, health systems of many developing countries were inspired by multiple existing transfer models to introduce these managerial practices according to new public management orientations. However, the used transfer models seem to ignore some action mechanisms as important aspects of this process. This paper aims at presenting the state of the art in transfer models of managerial practices in health systems. Ten main transfer models related to the research theme were identified. We organized the review around a number of questions that are raised explicitly or implicitly by the literature and observation on transfer models. The full implication became clear after using selected transfer models to answer to those questions. We found that existing transfer models highlighted key roles played by different actors involved and the importance of contextual factors in transfer processes. These transfer models lead to failure or success either in the same or in different settings. However, we realized that these transfer models ignore taking into account interactions which exist in transfer processes as well as the evolution of key actors and changes in contextual factors. There is a need to create new models for efficient transfer of managerial practices in health systems. We propose to develop, test, and discuss new transfer models that consider changes in transfer process and where interactions are highlighted in the perspective of performance improvement.



Developing countries, Health systems, Managerial practices, Performance perspective, Transfer models

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Jetté C, Goyette M. Social practices and managerial practices: possible convergences? New Soc Pract. 2010;22(2):25-34.

Marsh D, Sharman JC. Policy diffusion and policy transfer. Policy Stud. 2009;30(3):269‑88.

Gautier L, Tosun J, De Allegri M, Ridde V. How do diffusion entrepreneurs spread policies? Insights from performance-based financing in Sub-Saharan Africa. World Dev. 2018;110:160‑75.

Turcotte-Tremblay A-M, Gautier L, Bodson O, Sambieni NE, Ridde V. The role of global health actors in expanding performance-based funding in low-income countries. J Med Manag Econ. 2018;36(5):261-79.

Roland EEA. Performance based Financing as a Health System Reform: Success Story on how the Application Performance based Measures Improve Performance both in Quantity and Quality of Health in South West Region. Texila Int J Manag. 2019;5(1):66‑72.

Kiendrébéogo JA, Shroff ZC, Berthé A, Yonli L, Béchir M, Meessen B. Why performance-based financing in chad failed to emerge on the national policy agenda. Heal Syst Reform. 2017;3(2):80‑90.

Shroff ZC, Bigdeli M, Meessen B. From scheme to system (part 2): findings from ten countries on the policy evolution of results-based financing in health systems. Health Syst Reform. 2017;3(2):137‑47.

Wang S, Moss JR, Hiller JE. Applicability and transferability of interventions in evidence-based public health. Health Promot Int. 2006;21(1):76‑83.

Cambon L, Minary L, Ridde V, Alla F. A tool to support the transferability of health promotion interventions: ASTAIRE. Public Health. 2014;26:783-86.

Villeval M, Bidault E, Shoveller J, Alias F, Basson JC, Frasse C, et al. Enabling the transferability of complex interventions: exploring the combination of an intervention’s key functions and implementation. Int J Public Health. 2016;61(9):1031-8.

Fianu A, Villeval M, Naty N, Favier F, Lang T. Analyzing the transferability of an intervention: application of the key functions / implementation / context model to a diabetes prevention program. Public Health. 2017;29(4):525-34.

Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci. 2018;13(1):88.

May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, et al. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res. 2007;7(1):148.

Bertone M-P, Meessen B. Studying the link between institutions and health system performance: a framework and an illustration with the analysis of two performance-based financing schemes in Burundi. Health Policy Plan. 2013;28(8):847‑57.

Sieleunou I, Turcotte-Tremblay A-MM, Yumo HA. Transferring the purchasing role from international to national organizations during the scale-up phase of performance-based financing in Cameroon. Health Syst Reform. 2017;3(2):91‑104.

Street RB, Pringle P, Lourenço TC, Nicolletti M. Transferability of decision-support tools. Climate Change. 2019;153(4):523‑38.

Gandara D, Rippner JA, Ness EC. Exploring the ‘How’ in policy diffusion: national intermediary organizations’ roles in facilitating the spread of performance-based funding policies in the states. J Higher Educ. 2017;88(5):701‑25.

Abomo P. The diffusion of pay for performance in health system reforms in sub-Saharan Africa and the depoliticization of health intervention. Soc e Cult. 2018;21(2).

Burchett H, Blanchard L, Kneale D, Thomas J. Assessing the applicability of public health intervention evaluations from one setting to another: a methodological study of the usability and usefulness of assessment tools and frameworks. Health Res Policy Syst. 2018;16(1):88.

Chiang FFTT, Lemański MK, Birtch TA. The transfer and diffusion of HRM practices within MNCs: lessons learned and future research directions. Int J Hum Res Manag. 2017;28(1):234‑58.

Baldwin T, Ford K. Transfer of training: a review and directions for future research. Pers Psychol. 1988;41(1):63‑105.

Bracke D. Towards a theoretical model of transfer: the constraints to be respected. J Educ Sci. 1998;24(2):235-66.

Stone D. Understanding the transfer of policy failure: bricolage, experimentalism and translation. Policy Polit. 2017;45(1):55‑70.

Dormont B. Payment for performance: unethical or in the service of public health? Les Trib la santé. 2013;40(3):53.

Scott A, Sivey P, Ouakrim DA, Willenberg L, Naccarella L, Furler J, Young D. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011(9).

Bertone MP. The challenge of retaining health workers in rural areas: analysis of the strategies implemented in seven French-speaking African countries. Public Health. 2018;S1(HS):33-43.

Oxman AD, Fretheim A. Can paying for results help to achieve the Millennium Development Goals? Overview of the effectiveness of results-based financing. J Evid Based Med. 2009;2(2):70‑83.

Renmans D, Holvoet N, Criel B, Meessen B. Performance-based financing: the same is different. Health Policy Plan. 2017;32(6):860‑8.

Zeng W, Sun D, Nair D, Nam JE, Gheorghe A. Strengthening performance-based financing as a health system approach for quality improvement. J Glob Health. 2018;8(2).

Paul E, Albert L, Bisala BN, Bodson O, Bonnet E, Bossyns P, et al. Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?. BMJ Glob Health. 2018;3(1):e000664.

Turner E, Green S. Understanding policy convergence in Britain and Germany. Ger Polit. 2007;16(1):1‑21.

Ssengooba F, McPake B, Palmer N. Why performance-based contracting failed in Uganda- An “open-box” evaluation of a complex health system intervention. Soc Sci Med. 2012;75(2):377‑83.

Zeng W, Shepard DS, Rusatira J de D, Blaakman AP, Nsitou BM. Evaluation of results-based financing in the Republic of the Congo: a comparison group pre–post study. Health Policy Plan. 2018;33(3):392‑400.

Bodson O, Barro A, Turcotte-Tremblay A-M, Zanté N, Somé P-A, Ridde V. A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months. Arch Public Health. 2018;76(1):4.

Soucat A, Dale E, Mathauer I, Kutzin J. Pay-for-performance debate: not seeing the forest for the trees. Heal Syst Reform. 2017;3(2):74‑9.

Bresnen M, Marshall N. Understanding the diffusion and application of new management ideas in construction. Eng Constr Archit Manag. 2001;8(5/6):335‑45.

Björkman I, Lervik JE. Transferring HR practices within multinational corporations. Hum Resour Manag J. 2007;17(4):320‑35.

Minkman E, van Buuren MW, Bekkers VJ. Policy transfer routes: an evidence-based conceptual model to explain policy adoption. Policy Stud. 2018;39(2):222‑50.