Political Context and Health Financing Reform

Shiffman, Jeremy

doi:10.1080/23288604.2019.1633894

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…Political economy analysis is also useful as a broader frame that examines the context, structures, and relationships that generate systemic features; what Jeremy Shiffman, a political scientist, focusing on the politics and global health governance of health policy-making in low-income countries calls the “enduring political and social arrangements not easily altered by the actions of individuals”. 230 …”

Section: Section 6: the Political Economy Of Financing Phcmentioning

confidence: 99%

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Hanson

Brikci

Erlangga

et al. 2022

The Lancet Global Health

213

141

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Section: Section 6: the Political Economy Of Financing Phcmentioning

confidence: 99%

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Hanson

Brikci

Erlangga

et al. 2022

The Lancet Global Health

213

141

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“…Our study rather discovered a cohesive community of anti-policy actors, weak civil society mobilization and an existing political leadership that was not trusted at the regional level. An anti-reform ( Shiffman, 2019 ) alliance that emerged became an anti-policy entrepreneurial group ( Oborn et al , 2011 ) exploring various favourable moments of policy change opportunities to shut the capitation policy window ( Kingdon, 1985 ; Shiffman and Smith, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Why did Ghana’s national health insurance capitation payment model fall off the policy agenda? A regional level policy analysis

Abiiro¹,

Alatinga

Yamey

2021

Health Policy and Planning

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Provider payment reforms, such as capitation, are very contentious. Such reforms can drop off the policy agenda due to political and contextual resistance. Using the Shiffman and Smith (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet 2007; 370 1370–9) framework, this study explains why Ghana’s National Health Insurance capitation payment policy that rose onto the policy agenda in 2012, dropped off the agenda in 2017 during its pilot implementation in the Ashanti region. We conducted a retrospective qualitative policy analysis by collecting field data in December 2019 in the Ashanti region through 18 interviews with regional and district level policy actors and four focus group discussions with community-level policy beneficiaries. The thematically analysed field data were triangulated with media reports on the policy. We discovered that technically framing capitation as a cost-containment strategy with less attention on portraying its health benefits resulted in a politically negative reframing of the policy as a strategy to punish fraudulent providers and opposition party electorates. At the level of policy actors, pilot implementation was constrained by a regional level anti-policy community, weak civil society mobilization and low trust in the then political leadership. Anti-policy campaigners drew on highly contentious and poorly implemented characteristics of the policy to demand cancellation of the policy. A change in government in 2017 created the needed political window for the suspension of the policy. While it was technically justified to pilot the policy in the stronghold of the main opposition party, this decision carried political risks. Other low- and middle-income countries considering capitation reforms should note that piloting potentially controversial policies such as capitation within a politically sensitive location can attract unanticipated partisan political interest in the policy. Such partisan interest can potentially lead to a decline in political attention for the policy in the event of a change in government.

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“…By altering incentives and creating losers and winners, health financing reform fits the 1936 seminal definition of politics by Harold D. Lasswell who defined it as a competition about 'who gets what, when, and how' [ 9 ]. Thus, health financing reform is not a technical exercise, it is rather an arena of political competition through a complex interaction of ideas, institutions and interests with contested arguments and diverse stakeholders capable of facilitation or resistance—even veto policy options [ 10 , 11 ] . Despite the importance of assessing health financing reforms through a political economy lens, health financing reform in Zimbabwe is often presented from a technical perspective along a familiar pattern of detailed diagnosis of the health financing ‘gaps’; followed by a catalogue of ‘prescriptions’ on how to progress towards UHC.…”

Section: Introductionmentioning

confidence: 99%

The political economy of health financing reforms in Zimbabwe: a scoping review

Mhazo

Maponga

2022

Int J Equity Health

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Background Implementation of health financing reforms for Universal Health Coverage (UHC) is inherently political. Despite the political determinants of UHC, health financing reform in Zimbabwe is often portrayed as a technical exercise with a familiar path of a thorough diagnosis of technical gaps followed by detailed prescriptions of reform priorities. In this study, we sought to understand the interaction between political and economic aspects of health financing reforms since the country got its independence in 1980. Methods We conducted a scoping review of health financing reforms in Zimbabwe and reviewed 84 relevant sources of information. We then conducted a thematic analysis using an adapted Fox and Reich’s framework of ideas and ideologies, interests and institutions. Results We found that ideas, institutions and interests significantly influence health financing reforms in Zimbabwe with implications on health system performance. Reform priorities of the 1980s were influenced by socialist ideologies with an interest to address pervasive health inequities inherited from the colonial racial system. The progress in equity realized in the 1980s was severely disrupted from the 1990s partly due to neo-liberal ideologies which steered interests towards market-oriented reforms. The period from the 2000s is characterized by increasing donor influence on health financing and a cumulative socio-economic collapse that resulted in a sharp and protracted decline in health spending and widening of health inequities. Conclusion Health financing reform process in Zimbabwe is heavily influenced by political economy characteristics which favor certain financing arrangements over others with profound implications on health system performance. We concluded that the political economy factors that slow down UHC reforms are not rooted in the ambiguities of ideas on what needs to be done. Instead, the missing link is how to move from intention to action by aligning espoused ideas with interests and institutions which is an inherently political and redistributive process. International and domestic actors involved in UHC in Zimbabwe need to explicitly consider the politics of health financing reforms to improve the implementation feasibility of desired reforms.

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Political Context and Health Financing Reform

Cited by 12 publications

References 8 publications

The Lancet Global Health Commission on financing primary health care: putting people at the centre

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Why did Ghana’s national health insurance capitation payment model fall off the policy agenda? A regional level policy analysis

The political economy of health financing reforms in Zimbabwe: a scoping review

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