Momentum for policy change: alternative explanations for the increased interest in results- based financing in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
Results-based financing initiatives have been implemented in many countries as stand-alone projects but with little integration into national health systems. Results-based financing became more prominent in Uganda’s health policy agenda in 2014–2015 in the
context of the policy imperative to finance universal health coverage. Objective: To explore plausible explanations for the increased policy interest in the scale-up of results-based financing in Uganda. Methods: In this qualitative study, information was collected through key informant interviews, consultative meetings (2014 and 2015) and document reviews about agenda-setting
processes. The conceptual framework for the analysis was derived from the work of Sabatier,
Kingdon and Stone. Results: Four alternative policy arguments can explain the scale-up of results-based financing
in Uganda. They are: 1) external funding opportunities tied to results-based financing create incentives for adopting policies and plans; 2) increased expertise by Ministry of Health officials in the implementation of results-based financing schemes helps frame capacity accumulation arguments; 3) the national ownership argument is supported by increased desire for alignment and fit between results-based financing structures and legitimate institutions that manage the health system; and 4) the health systems argument is backed by evidence of the levers and constraints needed for sustainable performance. Shortages in medicines and workforce are key examples. Overall, the external funding argument was the most compelling. Conclusion: The different explanations illustrate the strengths and the vulnerability of the results-based financing policy agenda in Uganda. In the short term, donor aid has been the main factor shifting the policy agenda in favour of results-based financing. The high cost of
results-based financing is likely to slow implementation. If results-based financing is to find a good fit within the Ugandan health system, and other similar settings, then policy and action are needed to improve system readiness.
Description
Keywords
Policy change, result-based financing, policy deliberations, Uganda
Citation
Freddie Ssengooba, Aloysius Ssennyonjo, Timothy Musila & Elizabeth Ekirapa-Kiracho (2021) Momentum for policy change: alternative explanations for the increased interest in results-based financing in Uganda, Global Health Action, 14:1, 1948672, DOI: 10.1080/16549716.2021.1948672