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Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

BACKGROUND: The rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for ac...

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Autores principales: Gautier, Lara, Ridde, Valéry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683243/
https://www.ncbi.nlm.nih.gov/pubmed/29202091
http://dx.doi.org/10.1186/s41256-017-0043-x
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author Gautier, Lara
Ridde, Valéry
author_facet Gautier, Lara
Ridde, Valéry
author_sort Gautier, Lara
collection PubMed
description BACKGROUND: The rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The “donor-driven” push for policies aiming at UHC raises concerns about governments’ effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process. METHODS: We conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. Thirty-five (35) results were retrieved. We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation. RESULTS: The majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist. DISCUSSION: Future research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s41256-017-0043-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-56832432017-11-30 Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes Gautier, Lara Ridde, Valéry Glob Health Res Policy Research BACKGROUND: The rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The “donor-driven” push for policies aiming at UHC raises concerns about governments’ effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process. METHODS: We conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. Thirty-five (35) results were retrieved. We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation. RESULTS: The majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist. DISCUSSION: Future research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s41256-017-0043-x) contains supplementary material, which is available to authorized users. BioMed Central 2017-08-08 /pmc/articles/PMC5683243/ /pubmed/29202091 http://dx.doi.org/10.1186/s41256-017-0043-x Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Gautier, Lara
Ridde, Valéry
Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title_full Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title_fullStr Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title_full_unstemmed Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title_short Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes
title_sort health financing policies in sub-saharan africa: government ownership or donors’ influence? a scoping review of policymaking processes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683243/
https://www.ncbi.nlm.nih.gov/pubmed/29202091
http://dx.doi.org/10.1186/s41256-017-0043-x
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