Institutional pluralism, two publics theory and performance reporting practices in Zambia’s health sector

Abstract

Purpose The purpose of this paper is to investigate accounting and performance reporting practices embraced in the midst of a pluralistic institutional environment of an emerging economy (EE), Zambia. The research is necessitated due to the increased presence and influence of donor institutions whose information needs may not conform to the needs of local citizens in many EEs. Design/methodology/approach The study draws on institutional pluralism and Ekeh’s post-colonial theory of “two publics” to depict pluralistic environments that are typical of EEs. Primary data were collected through semi-structured interviews with 33 respondents drawn from the main stakeholder groups involved in health service delivery including legislators, policy makers, regulators, healthcare professionals and health service managers. Data analysis took the form of thematic analysis which involved identifying, analysing and constructing patterns and themes implicit within the data that were deemed to address the study’s research questions. Findings Findings indicate that Zambia’s institutional environment within the health sector is highly fragmented and pluralistic as reflected by the multiplicity of both internal and external stakeholders. These stakeholder groups equally require different reporting mechanisms to fulfil their information expectations. Social implications The multiple reporting practices evident within the health sector entail that the effectiveness of health programmes may be compromised due to the fragmentation in goals between government and international donor institutions. Rather than pooling resources and skills for maximum impact, these practices have the effect of dispersing performance efforts with the consequence of compromising their impact. Fragmented reporting equally complicates the work of policy makers in terms of monitoring the progress and impact of such programmes. Originality/value Beyond Goddard et al. (2016), the study depicts the usefulness of Ekeh’s theory in understanding how organisations and institutions operating in pluralistic institutional environments may be better managed. In view of contradictory expectations of accounting and performance reporting requirements between the civic and primordial publics, the study indicates that different practices, mechanisms and structures have to be embraced in order to maintain institutional harmony and relevance to different communities within the health sector.

Public sector accounting in emerging economies: a review of the papers published in the first decade of Journal of Accounting in Emerging Economies

“…To address the grievances of local legislators, the bureaucracy has, therefore, adopted a strategy of creative distraction that enables both budgetary and performance slacks. Similar tensions are addressed in the paper by Phiri and Guven-Uslu (2018*), which deals with conflicting stakeholder interests in the accounting and performance management systems of the Zambian health sector. This study, which uses Ekeh's theory on post-colonial “two publics”, shows that professionals had to accommodate conflicting interests, especially from international organisations – who are the key propagators of NPM ideas – and the Ministry of Health as a supporter of indigenous values, such as situating health-care provision closer to the location of clients.…”

“…The interpretive research published in JAEE provides rich evidence about the local context in which PSA reforms were adopted (see, e.g. Goddard and Mkasiwa, 2016*; Phiri and Guven-Uslu, 2018*; Tallaki and Bracci, 2019*). Unintended consequences in PSA in EE are generally envisaged as a result of the failure to consider the unique local contexts that vary across countries.…”

Stratified ontology, institutional pluralism and performance monitoring in Zambia’s health sector

“…The African context offers a rich research field for operationalising institutional pluralism due to the pluralistic environments existing in these countries. Several studies conducted in these countries confirm the evidence of the significant influence of supranational institutions on accounting, financial management and performance measurement and management (PMM) practices through their funding activities (Rahaman et al, 2007;Rahaman et al, 2004;Uddin and Tsamenyi, 2005;Phiri and Guven-Uslu, 2018).…”

“…While the HIV/AIDS expenditure has been on the rise relative to total donor funding, donor funding aimed at other parts of the system has stagnated during the same period (Shiffman et al, 2009). However, such 'vertical' funding mechanisms that bypass government structures may not always please African leaders since they are seen to ignore government policy and national health priorities (Phiri and Guven-Uslu, 2018). Governments of these countries accept these funds on the premise that donors subsidise the cost of running the health sector (Waddington, 2004) and provide the means for these countries to work towards their national health strategies and achieve their objectives.…”

“…Such an approach was deemed appropriate in view of pluralistic institutional environments existing in most African economies (including Zambia) that are also considered to be highly stratified (World Health Organisation, 2013;Yu, 2013;Wickramasinghe, 2015). The pluralistic nature of institutional environments in these economies is aggravated by the presence of donor and supranational institutions (such as the World Bank, United Nations, World Health Organisation,) who often have different institutional prescriptions from local stakeholders on funding and performance reporting (Rahaman et al, 2010;Phiri and Guven-Uslu, 2018). Such contradictions have the potential to compromise the quality of health service delivery in the absence of appropriate responses from actors operating at different levels of the health sector as attested by complaints from some government agencies in Zambia regarding the vertical application of donor-funded resources (Ministry of Health and World Bank, 2010).…”