Ownership of health financing policies in low-income countries: a journey with more than one pathway

Kiendrébéogo, Joël Arthur; Meessen, Bruno

doi:10.1136/bmjgh-2019-001762

Cited by 17 publications

(12 citation statements)

References 47 publications

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“…Rare examples of ‘reflexive learning’ for UHC are the National Health Assembly in Thailand23 and the societal dialogue in Tunisia (http://www.hiwarsaha.tn/). Building national coalitions is central to UHC and health financing policies 24. Yet, so far, few really paid attention to the ‘learning through bargaining’ generated at the level of decision-makers and national UHC ‘champions’, let alone learning which really starts in communities.…”

Section: Lessons For Countries and The Global Health Communitymentioning

confidence: 99%

Learning for Universal Health Coverage

Meessen¹,

Akhnif

Kiendrébéogo

et al. 2019

BMJ Glob Health

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The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. ‘Learning for UHC’ is a central component of countries’ health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes.

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Section: Lessons For Countries and The Global Health Communitymentioning

confidence: 99%

Learning for Universal Health Coverage

Meessen¹,

Akhnif

Kiendrébéogo

et al. 2019

BMJ Glob Health

Self Cite

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“…In Tanzania, like Afghanistan, the PBF policy process was politicised with outside actors having considerable influence on the agenda, thus allowing minimal flexibility for the Tanzanian authorities to effectively lead the process (20). PBF can be successful if all actors assume joint responsibility for the programme and the feeling of ownership to value and conform to the programme (56). The processes of interaction with actors and the implementation approach should retain flexibility, thus providing time for the development of local capacity and ownership, and to enable integration within the health system (22).…”

Section: Discussionmentioning

confidence: 99%

Political Economy Analysis of the Performance-Based Financing Programme in Afghanistan

Salehi

Blanchut²,

Vassal

et al. 2020

Preprint

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Background Performance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. Methods We used a political economy analysis framework which aims to understand the main dynamics that influence the adoption and design of a policy and facilitates the exploration of policy processes and the roles played by key actors at various stages of implementation. Retrospective qualitative research methods were employed. The data comprised transcripts of key informant interviews and a review of PBF related documents. Results This study discovered a range of contextual factors contributing to the introduction of PBF in Afghanistan. In addition, the study identified the role, power, interest, and ideas of actors in relation to PBF and the extent to which they were involved in and affected the design, adoption, and implementation of PBF programme in the country. Besides, the study described the process of PBF programme design and how it was implemented in practice, including nonconformities to the initial design and reasons for these. Discussion Political economy factors played a critical role in the introduction, design and implementation of PBF programme in Afghanistan. This study highlighted a number of contextual factors including global and local forces supporting the introduction of PBF in Afghanistan. The process underlying the design and implementation of the PBF programme was a result of power and resource dynamics between PBF programme actors. This study makes an important contribution to the global literature through its focus on a low-income setting and a fragile and conflict-affected state where numerous forces have combined to bring a programme into existence and have influenced its implementation and outcome. Conclusion PBF programmes are inherently political as they enforce distinct arrangements for the sharing of resources and represents a risk or opportunity to actors as a result of changes to their roles and responsibilities and the modification of organisational processes. Future studies are required to focus on conducting empirical research to understand the main political economy dynamics that influence the policy cycle of such programmes. We recommend further use of political economy analysis in such studies.

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“…Moreover, ownership should not be considered as a static property, but as both a function and feature of relationships between various actors involved in development co‐operation (Keijzer et al, 2018). For example, recent research on the ownership of health financing policies in low‐income countries identifies several “pathways” to ownership, thus demonstrating the value of a dynamic and relational understanding of this concept (Kiendrébéogo & Meessen, 2019). The importance of government leadership, then, ultimately depends on the approach to government and policy change adopted in the developing countries concerned.…”

Section: Defining and Researching Ownershipmentioning

confidence: 99%

“…Research on health financing policies confirms that a balanced relationship among both external actors and their development country counterparts may result in broad‐based ownership and support to government policies over time. Two essential pathways to such shared ownership are identified: (1) technicians first, politicians second, whereby a small group of actors is mandated to engage in small‐scale piloting; and (2) politicians first, technicians second, where a high‐level political decision—e.g., the abolition of citizen user fees for public health—is followed by the involvement of technical actors to “make it work.” Both approaches can—but also might not—lead to a situation of strong and balanced ownership (Kiendrébéogo & Meessen, 2019).…”

Section: Defining and Researching Ownershipmentioning

confidence: 99%

Special issue introduction Ownership in a post‐aid effectiveness era: Comparative perspectives

Keijzer

Black

2020

Development Policy Review

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Motivation: Close to 15 years have passed since the adoption of the Paris Declaration on Aid Effectiveness, which generated unprecedented efforts to advance effective development co-operation with a central focus on developing country ownership. Under today's international development co-operation realities, involving inclusive agendas, strategic divergence and increasing competition, discussions on ownership, harmonization and alignment have lost traction. Yet the practices of development co-operation relationships show strong continuities. Purpose: This special issue examines how the principle of ownership may be understood and advanced under these new conditions. National ownership is prioritized in the 2030 Agenda for Sustainable Development yet has so far been marginalized by a predominantly piecemeal response and by the rise of "mutual benefit" co-operation. Approach and Methods: This special issue takes an inductive approach to studying specific cases and actors bearing on the challenge of understanding and advancing ownership today, in order to inform future policy and research. The contributions to this special issue mainly draw from qualitative research designs that present detailed research inquiries into specific country and actor cases, drawing from interviews, structured desk reviews of policy documents and the rich body of literature on development effectiveness. They are complemented by two contributions that respectively present quantitative research and probe the critical and post-development literature for additional insights. Findings: Findings point to an increasing prevalence of pragmatism and self-interest among all actors, to the detriment of national ownership. Broad co-operation agendas, a sense of urgency interpreted as a search for quick results, and more diverse, interest-and outcome-driven forms of multistakeholder partnerships all entail a more assertive and proactive approach on the part of external actors. Under these conditions, local initiative may either become stifled or be reasoned away. Given this, today's dominant approaches to co-operation raise concerns about their ethics and sustainability. Policy implications: Ownership remains both a requirement and a desired outcome of international co-operation and is key to the effective O2 | KEIJZER and BLaCK

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Ownership of health financing policies in low-income countries: a journey with more than one pathway

Cited by 17 publications

References 47 publications

Learning for Universal Health Coverage

Learning for Universal Health Coverage

Political Economy Analysis of the Performance-Based Financing Programme in Afghanistan

Special issue introduction Ownership in a post‐aid effectiveness era: Comparative perspectives

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