Normalizing the political economy of improving health

Sparkes, Susan; Rivera, Paola Abril Campos; Jang, Hyobum; Marten, Robert; Rajan, Dheepa; Robb, Alastair; Shroff, Zubin Cyrus

doi:10.2471/blt.21.286629

Cited by 7 publications

(5 citation statements)

References 11 publications

(11 reference statements)

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“…[18][19][20][21] Political economy analyses are, therefore, critical to developing approaches to health policy that are attentive to power and that finetune the feasibility of policy solutions. 22 Political economy analyses have been crucial in expanding the knowledge base on health systems in LMICs to more rigorously engage with the politics of health policy development, such as the impact of political systems, power held by various international and domestic players in health policy, and the diffusion of ideas. 23 It is the intersection of these two major trends in health policy and systems research-increasing attention to the private healthcare sector and to political economy-that motivates this paper.…”

Section: What This Study Addsmentioning

confidence: 99%

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Sriram,

Yilmaz,

Kaur

et al. 2024

BMJ Glob Health

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The expansion of the private healthcare sector in some low-income and middle-income countries (LMICs) has raised key questions and debates regarding the governance of this sector, and the role of actors representing the sector in policy processes. Research on the role played by this sector, understood here as private hospitals, pharmacies and insurance companies, remains underdeveloped in the literature. In this paper, we present the results of a scoping review focused on synthesising scholarship on the role of private healthcare sector actors in health policy processes pertaining to health service delivery and financing in LMICs. We explore the role of organisations or groups—for example, individual companies, corporations or interest groups—representing healthcare sector actors, and use a conceptual framework of institutions, ideas, interests and networks to guide our analysis. The screening process resulted in 15 papers identified for data extraction. We found that the literature in this domain is highly interdisciplinary but nascent, with largely descriptive work and undertheorisation of policy process dynamics. Many studies described institutional mechanisms enabling private sector participation in decision-making in generic terms. Some studies reported competing institutional frameworks for particular policy areas (eg, commerce compared with health in the context of medical tourism). Private healthcare actors showed considerable heterogeneity in their organisation. Papers also referred to a range of strategies used by these actors. Finally, policy outcomes described in the cases were highly context specific and dependent on the interaction between institutions, interests, ideas and networks. Overall, our analysis suggests that the role of private healthcare actors in health policy processes in LMICs, particularly emerging industries such as hospitals, holds key insights that will be crucial to understanding and managing their role in expanding health service access.

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Section: What This Study Addsmentioning

confidence: 99%

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Sriram,

Yilmaz,

Kaur

et al. 2024

BMJ Glob Health

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“…The political economy of a health system shapes policy development and implementation in important ways (12). Conflicts of interests, poor interagency and multisectoral coordination, as well as excessive bureaucracy were among the most common challenges to fully institutionalizing evidence-informed health taxes policy recommendations (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Political Economy Analysis of Health Taxes (Tobacco, Alcohol Drink, and Sugar Sweteened Beverage): Case Study of Three Provinces in Indonesia

Ahsan,

Amalia,

Rahmayanti

et al. 2024

Preprint

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Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This study takes a problem-driven political economy analysis (PEA) approach to investigate the challenges and opportunities surrounding health tax implementation, with a particular focus on sub-national government in Indonesia, where the decentralization context of health tax remains understudied. Employing a qualitative methodology by collecting data from a total of twelve focus group discussions (FGDs) conducted in three provinces—Lampung, Special Region of/Daerah Istimewa (DI) Yogyakarta, and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs), and alcoholic beverages—we explore the multifaceted dynamics of health tax policies. These FGDs involved 117 participants, representing governmental institutions, non-governmental organizations (NGOs), and consumers. Our findings reveal that while health tax policies have the potential to contribute significantly to public health, challenges such as a lack of consumer awareness, bureaucratic complexities, and decentralized governance hinder implementation. Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardized packaging. Addressing these challenges is critical for realizing the full potential of health tax policies.

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“…Recently, scholars have turned to political economy analysis (PEA) as a means of providing explanations for the interaction of interests, institutions and ideas that determine health systems function or reform ( Rizvi et al. , 2020 ; Sparkes et al. , 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Political economy analysis of subnational health management in Kenya, Malawi and Uganda

Rodríguez

Balaji

Chamdimba

et al. 2023

Health Policy and Planning

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The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management systems and power dynamics of actors can have a significant influence on health managers’ ability to improve PHC access and quality. We conducted a problem-driven political economy analysis (PEA) in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. This PEA used document review and key informant interviews (N = 112) with government actors, development partners and civil societies in three districts or counties in each country (N = 9). We found that while decentralization should improve PHC by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. Emergent findings suggest that coronavirus disease 2019 (COVID-19) not only resulted in greater pressures on health teams and budgets but also improved relations with central government related to better communication and flexible funding, offering some lessons. Without addressing the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC and universal health coverage goals and the SDG agenda will remain out of reach.

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Normalizing the political economy of improving health

Cited by 7 publications

References 11 publications

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review

Political Economy Analysis of Health Taxes (Tobacco, Alcohol Drink, and Sugar Sweteened Beverage): Case Study of Three Provinces in Indonesia

Political economy analysis of subnational health management in Kenya, Malawi and Uganda

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