scholarly journals 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

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Giulia Loffreda ◽  
Kéfilath Bello ◽  
Joël Arthur Kiendrébéogo ◽  
Isidore Selenou ◽  
Mohamed Ali Ag Ahmed ◽  
...  
Keyword(s):  
Political Economy ◽  
Stakeholder Engagement ◽  
Health Financing ◽  
Research Process ◽  
The Political ◽  
Health Coverage ◽  
Research Uptake ◽  
Political Economy Analysis ◽  
Universal Health

Abstract Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.

scholarly journals The political economy of universal health coverage: a systematic narrative review

2020 ◽  
Vol 35 (3) ◽  
pp. 364-372 ◽  
Author(s):  
Syed Shahiq Rizvi ◽  
Rundell Douglas ◽  
Owain D Williams ◽  
Peter S Hill
Keyword(s):  
Political Economy ◽  
Case Studies ◽  
Universal Health Coverage ◽  
The Political ◽  
Health Coverage ◽  
Political Dimensions ◽  
National Ownership ◽  
Specific Interests ◽  
Political Framing ◽  
Universal Health

Abstract The uptake and implementation of universal health coverage (UHC) is primarily a political, rather than a technical, exercise, with contested ideas and diverse stakeholders capable of facilitation or resistance—even veto—of the policy uptake. This narrative systematic review, undertaken in 2018, sought to identify all peer-reviewed publications dealing with concepts relating to UHC through a political economy framing. Of the 627 papers originally identified, 55 papers were directly relevant, with an additional eight papers added manually on referral from colleagues. The thematic analysis adapted Fox and Reich’s framework of ideas and ideologies, interests and institutions to organize the analysis. The results identified a literature strong in its exploration of the ideologies and ideas that underpin UHC, but with an apparent bias in authorship towards more rights-based, left-leaning perspectives. Despite this, political economy analyses of country case studies suggested a more diverse political framing for UHC, with the interests and institutions engaged in implementation drawing on pragmatic and market-based mechanisms to achieve outcomes. Case studies offered limited detail on the role played by specific interests, though the influence of global development trends was evident, as was the role of donor organizations. Most country case studies, however, framed the development of UHC within a narrative of national ownership, with steps in implementation often critical political milestones. The development of institutions for UHC implementation was predicated largely on available infrastructure, with elements of that infrastructure—federal systems, user fees, pre-existing insurance schemes—needing to be accommodated in the incremental progress towards UHC. The need for technical competence to deliver ideological promises was underlined. The review concludes that, despite the disparate sources for the analyses, there is an emerging shared narrative in the growing literature around the political economy of UHC that offers an increasing awareness of the political dimensions to UHC uptake and implementation.

scholarly journals Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

2021 ◽  
Author(s):  
Maria Nannini ◽  
Mario Biggeri ◽  
Giovanni Putoto
Keyword(s):  
Political Economy ◽  
Universal Health Coverage ◽  
National Level ◽  
Health Financing ◽  
Negotiation Process ◽  
Financial Protection ◽  
Health Coverage ◽  
Financing System ◽  
The Government ◽  
Universal Health

Background: As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. Objective: This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods: The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector. Results: We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion: By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.

scholarly journals Role of Health Financing in Provision of Health Care and Universal Health Coverage in India

2020 ◽  
Author(s):  
Ranjit Kumar Dehury ◽  
Nishchala Sripathi ◽  
GVRK Acharyulu ◽  
Jagatabandhu Mohapatra ◽  
Surya Narayana
Keyword(s):  
Health Care ◽  
Local Governments ◽  
Central Government ◽  
Health Financing ◽  
Monitoring And Evaluation ◽  
Good Health ◽  
Provincial Government ◽  
Health Coverage ◽  
Universal Health

Financing is an important aspect of any program for successful transformation. Financial commitment of government is considered to be the highest form of commitment for successful work. Without budgetary provision, no program can achieve the desired target. The role of health financing of central government, international donor agencies, provincial government, and local bodies have been identified. The paper focused on monitoring and evaluation mechanisms for health financing in the context of recent developments. Health financing models have been discussed to gain an understanding about relation of financing and overall healthcare development. The search engines like PubMed, Scopus, Web of Sciences, and jstor (journal storage) were consulted to unearth the mechanism of health finances for development of good health. The paper put forth various themes and sub-themes according to financial implications on health structure of India. All healthcare programs need a continuous stream of resources like medicine, workforce, physical infrastructure, monitoring, and evaluation to achieve good health. Whereas, different stakeholders also need financial support to evolve with great vigour and vivacity. There is a pressing need to infuse financial resources into public health system for achievement of universal health care rather than incremental growth in traditional financial processes spreading over several decades. The specific roles and responsibilities of central, provincial, local governments and international donors have to be delineated to expedite resource mobilisation. However, while implementing programs, there should be coordination among all the stakeholders.

Mapping Power

2018 ◽  
Keyword(s):  
Political Economy ◽  
Comprehensive Analysis ◽  
Electricity Sector ◽  
Operational Performance ◽  
The Political ◽  
Government Reform ◽  
High Quality ◽  
The Past ◽  
Economic Forces ◽  
Political Economy Analysis

Electricity is critical to enabling India’s economic growth and providing a better future for its citizens. In spite of several decades of reform, the Indian electricity sector is unable to provide high-quality and affordable electricity for all, and grapples with the challenge of poor financial and operational performance. To understand why, Mapping Power provides the most comprehensive analysis of the political economy of electricity in India’s states. With chapters on fifteen states by scholars of state politics and electricity, this volume maps the political and economic forces that constrain and shape decisions in electricity distribute on. Contrary to conventional wisdom, it concludes that attempts to depoliticize the sector are misplaced and could worsen outcomes. Instead, it suggests that a historically grounded political economy analysis helps understand the past and devise reforms to simultaneously improve sectoral outcomes and generate political rewards. These arguments have implications for the challenges facing India’s electricity future, including providing electricity to all, implementing government reform schemes, and successfully managing the rise of renewable energy.

scholarly journals Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Kristen Meagher ◽  
Bothaina Attal ◽  
Preeti Patel
Keyword(s):  
Political Economy ◽  
Health Systems ◽  
Armed Conflict ◽  
Narrative Review ◽  
Health Systems Strengthening ◽  
The Political ◽  
Systems Research ◽  
Political Economy Of Health ◽  
And Gender

Abstract Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.

Sounds without borders: Exploring the cross-national expansion of commercial European Radio Groups

2021 ◽  
pp. 026732312110121
Author(s):  
Montse Bonet ◽  
David Fernández-Quijada
Keyword(s):  
Political Economy ◽  
The Political ◽  
Cultural Industries ◽  
Cross Border ◽  
National Market ◽  
The Cross ◽  
National Champions ◽  
Cross National ◽  
Expansion Strategies

This article aims to study how private European radio is becoming commercially international through the expansion of radio brands beyond their national market. It is the first ever analysis of the expansion strategies of radio groups across Europe, including their footprint in each market in which they operate, from the political economy of cultural industries. The article maps the main radio groups in Europe, analyses cross-national champions in depth and establishes three main types. This study shows that, thanks to the possibilities of a deregulated market, strengthening the role of the brand and the format, and the agreements with other groups, broadcasting radio has overcome the obstacles that, historically, hindered its cross-border expansion.

scholarly journals Employment based health financing does not support gender equity in universal health coverage

BMJ ◽  
2020 ◽  
pp. m3384 ◽  
Author(s):  
Lavanya Vijayasingham ◽  
Veloshnee Govender ◽  
Sophie Witter ◽  
Michelle Remme
Keyword(s):  
Gender Equity ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Health Coverage ◽  
Universal Health

scholarly journals Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

2021 ◽  
Vol 18 (4) ◽  
pp. 1382
Author(s):  
Marzena Tambor ◽  
Jacek Klich ◽  
Alicja Domagała
Keyword(s):  
Universal Health Coverage ◽  
European Countries ◽  
Eastern European ◽  
Health Coverage ◽  
Benefit Package ◽  
Significant Downward Trend ◽  
Out Of Pocket Payments ◽  
Eastern European Countries ◽  
Universal Health

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

The Saint with Indra's Sword: Khruubaa Srivichai and Buddhist Millenarianism in Northern Thailand

2014 ◽  
Vol 56 (3) ◽  
pp. 681-713 ◽  
Author(s):  
Katherine Bowie
Keyword(s):  
Political Economy ◽  
The State ◽  
Capital City ◽  
The Political ◽  
Northern Thailand ◽  
Present Evidence ◽  
Modern Context ◽  
A Charge ◽  
Social Causes

AbstractDespite a growing literature revealing the presence of millenarian movements in both Theravada and Mahayana Buddhist societies, scholars have been remarkably reluctant to consider the role of messianic beliefs in Buddhist societies. Khruubaa Srivichai (1878–1938) is the most famous monk of northern Thailand and is widely revered as atonbun, or saint. Althoughtonbunhas been depoliticized in the modern context, the term also refers to a savior who is an incarnation of the coming Maitreya Buddha. In 1920 Srivichai was sent under arrest to the capital city of Bangkok to face eight charges. This essay focuses on the charge that he claimed to possess the god Indra's sword. Although this charge has been widely ignored, it was in fact a charge of treason. In this essay, I argue that the treason charge should be understood within the context of Buddhist millenarianism. I note the saint/savior tropes in Srivichai's mytho-biography, describe the prevalence of millenarianism in the region, and detail the political economy of the decade of the 1910s prior to Srivichai's detention. I present evidence to show that the decade was characterized by famine, dislocation, disease, and other disasters of both natural and social causes. Such hardships would have been consistent with apocalyptic omens in the Buddhist repertoire portending the advent of Maitreya. Understanding Srivichai in this millenarian context helps to explain both the hopes of the populace and the fears of the state during that tumultuous decade.

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