Employing the policy capacity framework for health system strengthening

Abstract

The policy capacity framework offers relevant analytical ideas that can be mobilized for health system strengthening. However, the employment of this framework in the health field constitutes a relevant interdisciplinary gap in knowledge. This themed issue explores the relationships between the policy capacity framework and health system strengthening, in a multidimensional and interdisciplinary way, in high-income and low–middle-income countries. This introduction unpacks the dynamic interrelationships between the policy capacity framework and health system strengthening, bringing together common and distinct elements from both fields and summarizing possible relationships between them. The analysis shows that both fields together can increase our knowledge on health policies and system’s critical themes and reforms. This challenge could be followed by exploring the convergences between them, as far as concepts/themes (types of capacities and other themes) and levels of analysis are concerned. Although in varied ways, papers in this issue (based on European countries, China, Canada, New Zealand, India, Australia, and Brazil) advance the use of the policy capacity framework for health policy or system strengthening. They give two main interdisciplinary contributions. Critical capacities can be incorporated into the policy capacity framework for the analysis of system strengthening—capacity to adapt, contexts of mixed and complex systems, dynamic view of policy capacity, and policy capacity as a relational power. Policy capacity is contextually interpreted (relative to the problem frame) and dynamic and adaptive (processual and relational), in relation to the properties of a health system, particularly with regard to the existing and developing mixed and complex systems.

Policy mechanisms and types of participation in the implementation of the Brazilian pay-for-performance programme PMAQ

“…However, as these policies were being implemented, studies on P4Ps identified numerous mechanisms and unintended consequences that policy makers could not control. Themes such as the need for greater organisational capacity and other mechanisms to overcome staff demotivation and pressure caused by P4P came to be addressed extensively in research (Eijkenaar et al, 2013;Renmans et al, 2016;Saddi et al, 2023;Toonen et al, 2009). By investigating frontline staff behaviour, researchers have identified numerous "gaming and cheating" practices with P4P rules in a context of increased pressure in the work environment, generating numerous unintended consequences (Lewis, 2015;Pollitt, 2013).…”

Guest editorial: Payment for performance: comparing policy making, design and implementation in health, social care and education

“…To be sure, not all studies have been focusing on impact and several studies have instead focused on the processes and mechanisms triggered by P4P/PBF (De Allegri et al , 2018; Lohmann et al , 2018; Renmans et al , 2020; Singh et al , 2021; Saddi et al , 2021a, b, 2023). This certainly helps us to better understand how these programmes work and even to some extent how context may impact its effectiveness.…”

“…Despite the significant proliferation of P4P and performance-based schemes in health systems and their utilisation for wider system initiatives such as promoting universal health care, raising service quality or increasing investment in specific areas of care; the evidence of health outcome effect remains mixed (Renmans et al , 2016; Paul et al , 2018; Singh et al , 2021; Diaconu et al , 2022; Saddi et al , 2023). Moreover, the paper by Kristensen and colleagues in this special edition highlight the vast range in system design while arguing that research and literature on performance schemes often remains siloed in LMICs, MICs and HICs with little cross-over or use of comparative analysis, as also emphasised as well by two earlier special issues (Saddi et al , 2018, 2021) and a satellite session at Health Systems Global (Anselmi et al , 2020) – something we start to address in this special edition.…”

“…Yet, concerns about the effectiveness of P4P/PBF and its underwhelming evidence-base as a strategic reform tool stem from the 1980s in relation to the private sector, the point at which many of the practices were being adopted in public service sectors. In particular, critical attention has been focused on the importance of considering both extrinsic (which covers schemes like PBF and other policy drivers and the wider context of implementation) and intrinsic drivers which have been shown to be wider than simply monetary reward (Saddi et al , 2023).…”

The marble cake of social services in Italy and Spain: Policy capacity, social investment, and the national recovery and resilience plans

“…These two fields of scholarship have rarely (if ever) been compared and combined. By adopting a policy capacity approach (Brenton et al, 2022;Saddi et al, 2023;Wu et al, 2015Wu et al, , 2018 to the study of SI, we aim to analyse the intergovernmental set of competences by which governmental organisations perform SI functions with respect to two dimensions of policy capacity: analytical and operational Lippi, 2021, 2022;Denis et al, 2022;Wu et al, 2018). We believe that such cross-fertilisation has much to offer with regard to advancing our understanding of intergovernmental relations in the social service system.…”