{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T03:54:01Z","timestamp":1769831641027,"version":"3.49.0"},"reference-count":96,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Institute of Tropical Medicine (ITM) in Antwerp, Belgium, under the framework agreement with DGD","award":["FRM-1178v1.0"],"award-info":[{"award-number":["FRM-1178v1.0"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2024,10,14]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Achieving universal health coverage (UHC) through an effective health financing system is a challenge for many low-income countries. Learning is key to success due to many uncertainties and unknowns. Using the case of translating strategic health purchasing into policy and practice in Burkina Faso, our study seeks to understand how policy learning can shape policy processes and outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a qualitative case study design and Dunlop and Radaelli\u2019s conceptualisation of policy learning to identify which modes of learning did or did not occur, what helped or hindered them and the resulting policy outcomes. Dunlop and Radaelli frame policy learning as epistemic, reflexive, negotiative or hierarchical. We collected data through documentary review and in-depth individual interviews with 21 key informants. We analysed the data manually using pattern-matching techniques.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The introduction of strategic health purchasing in Burkina Faso was initially seen as an opportunity to reduce the fragmentation of the health financing system by coupling a performance-based financing scheme and a user fee exemption policy. However, this has faltered, and our findings suggest that an inability to harness all modes of learning has led to blockages. Indeed, while reflective learning was present, epistemic, hierarchical and learning through bargaining were absent, preventing national policy actors from defending their own policy or scheme from reaching compromises. But thanks to facilitating processes led by a well-resourced organisation and contextual elements that encouraged the emergence of more pluralistic modes of learning, some progress was achieved in operationalising strategic health purchasing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Some modes of learning seem to be overlooked in countries\u2019 efforts to achieve UHC. Facilitation techniques and initiatives that encourage the use of all modes of learning, while supporting countries to take full ownership and responsibility for consolidating their own learning health systems, should be promoted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-015488","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T21:50:15Z","timestamp":1731534615000},"page":"e015488","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Using a policy learning lens to understand health financing policy outcomes: the case of translating strategic health purchasing into policy and practice in Burkina Faso"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7000-3712","authenticated-orcid":false,"given":"Jo\u00ebl Arthur","family":"Kiendr\u00e9b\u00e9ogo","sequence":"first","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium"},{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8677-1337","authenticated-orcid":false,"given":"Manuela","family":"De Allegri","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6344-3007","authenticated-orcid":false,"given":"Wim","family":"Van Damme","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Meessen","sequence":"additional","affiliation":[{"name":"Health Financing and Economics, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"2025073013132982000_9.11.e015488.1","unstructured":"World Health Organization . The world health report: health systems financing: the path to universal coverage. WHO; 2010."},{"key":"2025073013132982000_9.11.e015488.2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.12.113985"},{"key":"2025073013132982000_9.11.e015488.3","doi-asserted-by":"crossref","DOI":"10.1186\/s41256-021-00190-7","article-title":"Health financing for universal health coverage in Sub-Saharan Africa: a systematic review","volume":"6","author":"Ifeagwu","year":"2021","journal-title":"Glob Health Res Policy"},{"key":"2025073013132982000_9.11.e015488.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8510(00)00149-4"},{"key":"2025073013132982000_9.11.e015488.5","unstructured":"World health organization . Financing for universal health coverage: dos and don\u2019ts. In: Health financing guidance n\u00b09. 2019."},{"key":"2025073013132982000_9.11.e015488.6","unstructured":"Mathauer I , Dale E , Meessen B . Strategic Purchasing for Universal Health Coverage: Key Policy Issues and Questions: A Summary from Expert and Practitioners\u2019 Discussions. Geneva, 2017."},{"key":"2025073013132982000_9.11.e015488.7","unstructured":"Mathauer I , Dale E , Jowett M , et al . Purchasing Health Services for Universal Health Coverage: How to Make It More Strategic. Geneva, 2019."},{"key":"2025073013132982000_9.11.e015488.8","unstructured":"World Health Organization . The world health report 2000 - health systems: improving performance. Geneva, 2000."},{"key":"2025073013132982000_9.11.e015488.9","unstructured":"World Health Organization . Governance for Strategic Purchasing: An Analytical Framework to Guide a Country Assessment. 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