ArticleGlobal health action2021
Momentum for policy change: alternative explanations for the increased interest in results-based financing in Uganda.
Article in Global health action, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Prospective policy analysis-a critical interpretive synthesis review.Health policy and planning · 2024Review
- Development assistance, donor-recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank-UK and Global Fund in China.Global health research and policy · 2024Article
- Midwives' perspectives about using individualized care plans in the provision of immediate postpartum care in Uganda; an exploratory qualitative study.BMC nursing · 2023Article
- Comparative effectiveness of financing models in development assistance for health and the role of results-based funding approaches: a scoping review.Globalization and health · 2023Article
- Readiness of rural health facilities to provide immediate postpartum care in Uganda.BMC health services research · 2023Article
- Exploring the roles of players in strategic purchasing for healthcare in Africa-a scoping review.Health policy and planning · 2023Article
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Abstract
backgroundResults-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.
objectiveTo explore plausible explanations for the increased policy interest in the scale-up of results-based financing in Uganda.
methodsIn 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.
resultsFour 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.
conclusionThe 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.
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