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Institutional Framework - P4H Network

Institutional Frameworks: a key foundation to achieving sustainable financing for social health protection

Progression towards countries’ universal health coverage (UHC) through social health protection (SHP) is facilitated by a strong foundation built on institutional frameworks. The P4H Network provides targeted support at country level where requests correspond to P4H’s goal.

What makes up an institutional framework?

Two broad components make up the institutional frameworks for SHP and health financing (HF). Policy frameworks encompass policies, national strategies, plans and programs impacting SHP and HF. Though they reflect arbitrations and decisions made at the highest levels by executive powers (presidential or governmental), policy frameworks are not legally binding. Examples include policies like those on free health care, social health insurance and national strategies addressing HF, UHC, social protection and domestic resources mobilization.

Legal and regulatory frameworks are legally binding texts elaborated by legislative or executive powers, as well as the structures established by a legally binding source impacting SHP and HF. Examples of texts are UHC laws, health fund statutes and decrees. Examples of structures are social security or equity funds, health agencies and UHC units. 

How institutional frameworks are part of the P4H goal

Institutional frameworks define the institutional capacities of a country to progressively institute UHC, such as whether a country has established a supportive environment and robust institutional arrangements. The P4H Network’s results framework references institutional reforms implicitly, as an intermediary outcome of selected SHP and HF reforms.  The P4H Coordination Desk (P4H-CD) and P4H country focal persons (P4H-CFPs) support country-level collaboration for improved institutional frameworks around SHP and HF as requested. 

The role of P4H-CFPs and support in 2023

At the 10th P4H Coordination Team Meeting, in 2022, P4H-CFPs requested greater support from the P4H-CD. Institutional frameworks were identified as an area for increased attention. Concrete examples of progress in this area in 2023, building on the deep dives developed previously, are Côte d’Ivoire and Cambodia. At the request of the P4H-CFP, Virgile Pace contributed to the “National experience-sharing workshop on the universal health coverage program in Côte d’Ivoire” with a virtual presentation in February. Support has also been provided to Cambodia, in close collaboration with Deutsche Gesellschaft für Internationale Zusammenarbeit  and the P4H-CFP there, Niccolò Rottigliano. The aim is to find concrete options, from a legal and regulatory perspective, to strengthen HF and speed up progress towards UHC, based on best practices and lessons learned in other countries in the region.

Deep dive into 10 countries

In 2022, Virgile Pace, an expert in institutional frameworks, worked with the P4H Network. He investigated institutional frameworks in 10 countries among those where the P4H Network had P4H-CFPs: Burundi, Cambodia, Chad, Côte d’Ivoire, Ethiopia, Mozambique, Myanmar, Namibia, Niger and Senegal