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Dfid health seminar slides 270416 tk

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The Political Economy of Maternal Health Care in Developing Countries

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Dfid health seminar slides 270416 tk

  1. 1. The political economy of maternal health care in developing countries DFID, 27 April 2016 Tim Kelsall, ODI Frederick Golooba-Mutebi, ESID and Independent Sam Hickey, ESID/GDI, University of Manchester
  2. 2. Overview 1. Introduction to ESID 2. Researching the Politics of Health Care 3. Key findings from the case studies 4. Policy implications 5. Discussion
  3. 3. 1. Introduction
  4. 4. ESID www.effective-states.org  Global Development Institute, University of Manchester  A DFID-funded research centre, 2011-2016  Sub-Saharan Africa, South Asia, Latin America Key research question  Under what political conditions do developmental forms of state capacity and elite commitment emerge and become sustained?
  5. 5.  Please add text here  Please add text here  Please add text here  Please add text here  Please add text here Political settlement Competitive clientelist Dominant coalition Country Ghana Bangladesh South Africa Rwanda Uganda Accumulat- ion Growth/SBRs Growth/ SBRs Growth/ SBRs Growth/SBRs Growth/SBRs Hydrocarbons/ Mining Hydrocarbons Redistribut- ion Education Health Education Health Education Education Health Social protection Education Health Social protection Recognition Gender Spatial inequity Gender Gender Gender Gender Spatial inequity Global PEA PSR PEA PSR PSR PEA PSR
  6. 6. 2. Researching the Politics of Health Care
  7. 7. The countries Country PS Type Key features Rwanda Dominant Long time-horizon, strong coordination capacity Ghana Competitive Short-time horizon, weak coordination capacity Uganda Dominant (interstitial) Short-time horizon, mixed coordination capacity Bangladesh Competitive (interstitial) Short-time horizon, mixed coordination capacity
  8. 8. Our causal model POLICY DOMAIN POLITICAL COMMITMENT TO MATERNAL HEALTH HR AND GOVERNANCE ARRANGEMENTS MATERNAL HEALTH PROGRESS POLITICAL SETTLEMENT POLICY ADOPTION AND DESIGN FUNDING
  9. 9. Our approach • Political settlement mapping interviews/exercises at national and sectoral level • Analytical narratives linking evolution in PS to health policy, implementation, and performance • Comparison of better and worse performing districts (MMR) for additional insight • Advice about how to work, developmentally, in different political contexts
  10. 10. 3. Key findings from the case studies
  11. 11. Rwanda • Dominant settlement facilitates sound policies and rigorous implementation – Top-down (performance contracts ) and diagonal (league tables) accountability – Problem solving approach, eg TBAs>midwives; SMS; antenatal wards – Joined up approach
  12. 12. Ghana, Uganda, Bangladesh • Competitive or intermediate settlements lead to populist policy making and/or slipshod implementation – Ghana: NHIS bankrupting local health facilities; CHPS compunds lack basic equipment and staff; 90% budget spent on salaries – Uganda: Districtization leads to proliferation of local health depts w/o qualified or experienced staff – Bangladesh: ‘Elite consensus’ around doctor absenteeism; mushrooming of CCs w/o proper facilities
  13. 13. However • All three poorer performers have some pockets of effectiveness and successful multistakeholder initiatives – Ghana, Upper East: P of E around Regional MO – Uganda, Lyantonde: dominant local coalition enforced performance and leveraged sons of the soil – Bangladesh: vigorous NGO and private sector
  14. 14. MMR trends in our case study countries 0 200 400 600 800 1000 1200 1400 1600 1990 1995 2000 2005 2010 2013 Bangladesh Ghana Rwanda Uganda
  15. 15. 4. Policy implications
  16. 16. Health system strengthening • In dominant settlements like Rwanda, traditional health system strengthening approaches are likely to pay dividends • In other types of settlement, there is insufficient national level political commitment for conventional approaches to work well. Maternal health policy needs to be more innovative, building out from pockets of effectiveness
  17. 17. ‘Best fit’ strategies Type of settlement Best ‘fit’ approach Dominant developmental Government supporting Competitive or intermediate Government connecting/brokering Dominant predatory? Government substituting?
  18. 18. 5. Discussion

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