Political Economy Analysis on Healthcare Financing

Imagine a world where everyone, regardless of their income or social status, has access to quality healthcare. This is the goal of universal health coverage (UHC), a complex challenge facing low- and middle-income countries (LMICs). Achieving UHC isn’t just about building hospitals or training doctors; it’s also about navigating the intricate web of politics and economics that influence healthcare systems.

Researchers are increasingly using political economy analysis (PEA) to understand these complexities. PEA goes beyond simply looking at the technical aspects of healthcare and delves into how power, resources, and different interests play out in shaping healthcare policies and reforms.

But there’s a crucial missing piece in many of these studies: the voices of the stakeholders. These are the individuals and organizations who are directly affected by UHC policies – from government officials to health providers, donors, and community members. They are not just sources of information, but key partners in shaping the research and ensuring its relevance.

A recent review of research on UHC and health financing reforms in LMICs found that while many studies acknowledge the importance of stakeholders, they often only involve them in data collection, not in the broader research process.

This limited engagement creates a gap between research and real-world application. Why? Because there are challenges to genuine stakeholder involvement:

•  The specialized nature of PEA: It requires specific skills and knowledge that not all stakeholders possess.

•  The sensitivity of the topics: Discussions about power dynamics and resource allocation can be politically charged and difficult to navigate.

•  The blurred lines of roles: It can be unclear how stakeholders should participate and what their responsibilities are.

But the need for stakeholder engagement is undeniable. It’s essential for ensuring that research is relevant, impactful, and ultimately leads to better healthcare outcomes for everyone.

To bridge this gap, researchers are exploring new approaches:

•  Early involvement: Including stakeholders from the very beginning of the research process, not just during data collection.

•  Local partnerships: Collaborating with researchers and organizations within the country to ensure local context is considered.

•  Building trust and transparency: Creating an open and honest environment where stakeholders feel heard and valued.

Political economy analysis (PEA) is useful for advancing health financing reforms towards universal health coverage (UHC). It can help understand stakeholder interests, power dynamics, and contextual factors that influence the feasibility of reforms. Achieving universal health coverage (UHC) is a key global health priority, but actually designing and implementing effective health financing reforms to expand coverage and financial protection can be politically challenging. This is where political economy analysis (PEA) comes in as a crucial tool.

PEA examines the interactions between political and economic processes in a society – the distribution of power and interests between different groups. By understanding the stakeholders involved in health financing reform, their relative power, interests and positions, as well as the broader institutional and contextual factors, strategies can be developed to navigate political obstacles and increase the chances of successful reform adoption and implementation.

World Health Organization outlines a 6-step process for conducting PEA to support health financing reforms:

1.  Assemble a “change team” – a small group of informed stakeholders with a personal/professional stake in the reforms.

2.  Select the specific health financing reform(s) to analyze, considering both impact and feasibility.

3.  Understand the broader reform context – factors like financing structures, political dynamics, windows of opportunity, implementation challenges, and equity impacts.

4.  Map out the key stakeholders, their interests, power, and positions related to the reform.

5.  Develop strategies to manage stakeholder interests and increase reform feasibility.

6.  Follow through on reform implementation, monitoring the effectiveness of stakeholder management approaches.

By incorporating this PEA process alongside technical health financing assessments and strategy development, policymakers can devise more politically feasible and impactful reforms to advance UHC. It’s about blending the technical and the political to navigate complex health system change.

Reference 

1.  World Health Organization (WHO). (2024). Political Economy Analysis for Health Financing: A ‘How to’ Guide. Geneva: World Health Organization.

2.  Lofreda, G., Bello, K., Kiendrébéogo, J. A., Mohamed Ali Ag Ahmed, I. S., Dossou, J. P., Witter, S., & Bertone, M. P. (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 Planning, 36(1), 1-14.