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Political Economy Tool - P4H Network

A tool to structure our approach to understanding political economy

Achieving Universal Health Coverage (UHC) through social health protection and health financing systems reforms across the countries in which P4H works is more than a technical challenge.

Many technical issues such as user fee removal, health taxes, introduction of social health insurance, or the subsidization of vulnerable people, are politically sensitive. Understanding why the removal of user fees was successful in Sierra Leone, why performance based financing led to improved health outcomes in Rwanda or why capitation payment became a nationwide reform in some countries, but not in other, requires an analysis of the political economy of the countries in which the reforms take place.

Country experiences suggests that the success of national social health protection and health financing reforms will be difficult without political support and commitment. 

It is also evident that partnership collaboration works if it builds on political economy variables dealing with ideology, idea, interest and institution. Therefore, understanding of the political economy (i.e. the social, economic and political conditions within which a technical reform sits) is essential to be able to navigate reforms. This need was recognized during many P4H organized meetings and events. The main target is the P4H Country Focal Persons (CFPs) who are deployed or appointed in countries directly engage with the complex political economy dynamics of their countries and support them to systematically integrate a structured political economy lens into their technical work.

The P4H Network has taken initiative to develop a Political Economy Tool (PET) aimed at supporting a structured political economy approach to understanding their country specific political situations and windows of opportunities for enhanced partnerships. The PET outlines how to identify the ideologies behind stakeholders‘ policy positions, how to understand where their ideas come from, what the interests of each stakeholder are, and where the institutions (formal and informal) sit in relation to a particular reform.
The PET takes a four-step approach. First, understanding of the problem that CFPs are grappling with (what specific reform is meeting blockages or requires coalition building). Second, review of existing evidence and discussions to map out each stakeholder’s power and interest. Third, development of an action plan to foster collaboration, and finally, timely review and mapping as political economy conditions are dynamic and require regular monitoring.
  • Case studies focusing on political economy of partnership collaboration are scarce in international literature.
  • P4H plans to test and pilot the PET in Cameroon and Cambodia in the first half of 2023.
  • Cameroon is a country where the government’s UHC agenda is progressing slowly and requires a deeper understanding on the part of P4H to support coalition building.
  • In Cambodia, partnership collaboration is well established among P4H partners. It is expected that the upcoming July elections will present an opportunity to continue and strongly consolidate support behind the government’s social protection reforms. Lessons learnt from these case studies will be shared and used to further refine the PET.
Bayarsaikhan Dorjsuren
P4H Coordination Desk, WHO
Peter Hill
Associate Professor, University of Queensland, Australia
Virgile Pace
P4H Consultant on legal and institutional framework
Htet Nay Lin Oo
P4H CFP in Myanmar
Cristina Manzanares
P4H CFP, Mozambique
Lou Tessier
Social Protection Department, ILO
Nouria Brikci
P4H Consultant on Political Economy
Aminata Nana
P4H CFP in Cameroon
Niccolo Rotigliano
P4H CFP in Cambodia

The tool piloted in Cambodia and Cameroon to refine and finalize.


P4H CT meeting reviewed, a consultant recruited, and CFPs engaged to update the tool


Tool revised with technical inputs of ILO and WHO


Tool draft discussed and tested by CFPs in Myanmar and Senegal


The University of Queensland is contracted


Literatures reviewed and repository developed


P4H validated the PE topic.


Political economy (PE) is proposed to P4H.

  • SOAS, University of London, also specializes in questions of political economy