What affects the performance of hospital financing interventions in low and lower-middle income countries from the program design and implementation perspective? A scoping review.

Hospitals, as an important component of the health system, consume a substantial amount of health resources and are instrumental in improving population health. While many health financing interventions have been implemented at hospitals, evidence exploring common factors facilitating their implementation in low and lower-middle income countries (LLMICs) remains limited. We conducted a scoping review of existing hospital financing interventions in LLMICs. A combination of search strategies and key informant consultations were used to search for relevant literature. A total of 35 articles spanning six categories of hospital financing interventions were included in the review. The review centered on design and implementation factors associated with hospital financing interventions. Factors affecting a hospital financing intervention's results were numerous and context specific. From the design and implementation perspective, five interconnected factors-governance and accountability, participatory process, proper intervention design, adequate resources and capacity, and monitoring and evaluation-underline the most influential factors across the six categories of hospital financing interventions. Understanding the connections among these factors and making efforts to align them with the country's context make for a more promising intervention. The evidence on specifics across different types of hospital financing implementations remains limited, requiring more implementation studies guided by comprehensive theoretical frameworks to generate more concrete evidence.