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Introduction: Results-based financing (RBF) was presented by its advocates as an effective tool for improving Burkina Faso’s health care system, and an essential step toward implementing universal health coverage (UHC) in the country. It was initially introduced in 2011, and suspended in 2018. Purpose of the study: Using a conceptual framework built around the triptych of the causes, mechanisms, and outcomes of institutional change, we sought to understand how RBF was introduced in Burkina Faso, and how it contributed to the country’s drive to implement UHC. Results: RBF was perceived as an external policy, essentially advocated by the World Bank. It relied on a group of actors operating outside the organizational structure of the Ministry of Health. Its impact on health indicators and the health care system has been mixed, and it has not enabled the country to put itself on a path to implementing UHC. It was not adopted by the key actors in the health care system, which is why it was discontinued without being rolled out at the national level. Conclusions: This study highlights the need to take the local context into account when designing and implementing health care programs.