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.

Background: For the past twenty years, African countries have experienced a massive deployment of performance-based financing practices within health systems. These numerous transfers involved several actors of different profiles and who intervened at different levels. At a time when many actors in their diversity are playing key role in the success or failure of the transfer process, the role of actors’ interactions in the transfer process of performance-based financing practices remains however less explored in context and in depth. This paper aimed to explore the role of actors’ interactions in the deployment of this process within Burundi health system.Methods: We conducted a case study of the transfer of performance-based financing practices within Burundi health system. 32 semi-structured interviews were carried out in addition to documentary technique and observation. In a qualitative approach, our interpretive approach followed an abductive reasoning to interpret the data collected. Conceptualization using NVivo12 software allowed to perform thematic and content analysis.Results: We argued that the transfer setting, the organizational specifics, the nature of the transferred practices, the levels of operationalization and the actors’ perceptions are determining factors of the deployment of the transfer process of performance-based financing practices. Moreover, the actors’ interactions as well as their causes and their effects affect the deployment of the transfer process.Conclusions: The actors’ interactions are shown to play moderating and mediating roles in the process of transferring those practices. Future research could focus on verifying and validating this role with quantitative methods.