Table 1.

Summary of main findings

Problem stream	Politics stream	Policy stream
Key event: National symposium on reproductive health in Yaoundé (1999) Key publication: “Cameroon country status report: Reversing the Decline in Health Outcomes” (2003) Recognition of:  ➢ poor health outcomes, especially for maternal & child health indicators  ➢ inefficiency regarding financial resources, some of which were provided by international donors  ➢ highly centralized management of the health system  ➢ disjunction in health program implementation between the peripheral & the central level  ➢ need for a better health financing policy	The fight against corruption became a high-priority mandate:  ➢ Sparrowhawk operation  ➢ National Anti-Corruption Commission  ➢ prosecution of some officials PBF was framed as a way to fight against corruption Endorsement of PBF approach by newly appointed Minister of Public Health	Loans and grants to implement PBF from the World Bank & the Health Results Innovation Multi Donor Trust Fund program Context of institutional reforms with the adoption of the sector wide approach (SWAP)  ➢ an attempt to improve the coordination of the development assistance for health  ➢ seen as a tool for improving aid effectiveness by ensuring policies, budgets and institutional arrangements, and to improve the sectoral performance. Existence of a contracting process within the health sector that started in the early 2000s.
Policy entrepreneurs
Work Bank representatives acted as policy entrepreneurs by:  ➢ initiating a policy dialogue with decision makers from the Ministry of Public Health, through meetings and presentations of evidence from Rwanda  ➢ initiating & supporting the participation of a delegation of officials from the Ministry of Public Health in a PBF study tour in Rwanda A network of PBF entrepreneurs influenced the position of international bilateral agencies (E.g.: GIZ) regarding PBF Entrepreneurs had good communication, lobbying and networking skills as well as important political connections.
Windows of opportunity
Windows of opportunity were created which contributed to pushing PBF higher onto the agenda:  ➢ a series of meetings & international workshops on PBF  ➢the deadline of the MDGs and the government’s priority to achieve these MDGs  ➢ other countries in Sub-Saharan Africa were adopting PBF  ➢ a reform of public finance marked a shift from an input-based budget to a results-based budget in many sectors such as health and education the Ministry of Public Health made PBF a high priority within the Implementation of the Health Sector Support Investment Project (HSSIP), under the SWAP