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.
- 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 DorjsurenP4H Coordination Desk, WHO
Peter HillAssociate Professor, University of Queensland, Australia
Virgile PaceP4H Consultant on legal and institutional framework
Htet Nay Lin OoP4H CFP in Myanmar
Cristina ManzanaresP4H CFP, Mozambique
Lou TessierSocial Protection Department, ILO
Nouria BrikciP4H Consultant on Political Economy
Aminata NanaP4H CFP in Cameroon
Niccolo RotiglianoP4H 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.
- Giulia Loffreda, Kéfilath Bello etol 2021. Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process. Health policy and Systems, BMC.
- Kevin Croke, Mariana Binti Mohd Yusoff etol. 2019. The political economy of health financing reform in Malaysia. Health Policy and Planning.
- Viroj Tangcharoensathien, Walaiporn Patcharanarumol etol. The Political Economy of UHC Reform in Thailand: Lessons for Low- and Middle-Income Countries. Health Systems and Reform.
- Lavers, Tom (2016): Understanding elite commitment to social protection: Rwanda’s Vision 2020 Umurenge Programme, WIDER Working Paper, No. 2016/93, ISBN 978-92-9256-136-9, The United Nations University World Institute for Development Economics Research (UNU-WIDER), Helsinki
- Susan P. Sparkes, Jesse B. Bump, Ece A. Özçelik, Joseph Kutzin & Michael R. Reich (2019): Political Economy Analysis for Health Financing Reform, Health Systems & Reform, DOI: 10.1080/23288604.2019.1633874