Table 1 Political economy themes used in study
From: The political economy of results-based financing: the experience of the health system in Zimbabwe
Domain | Topic | Questions posed |
|---|---|---|
Context | Historical legacies | What is the past history of the sector, including previous health reform initiatives and experience of crisis? How do these influence current stakeholder perceptions? How far did RBF respond to or reflect these historical legacies? |
Ideologies and values | What are the dominant ideologies and values which shape views around the health sector? To what extent did these influence the adoption of RBF? How have they been altered by it? | |
Framing of concept | How was RBF portrayed by key stakeholders in the adoption phase? How did this framing change over time? What is the dominant narrative behind RBF? Is there a consensus or disagreement on what it means or how it is meant to work? | |
Actors | Decision making | How are decisions made within the health system in Zimbabwe? Who is party to these decision-making processes? What role does evidence play? How are trade-offs managed? How were these reflected in the adoption, adaption and implementation of RBF? Has RBF influenced these processes in turn? |
Roles and power relationships | Who are the key stakeholders in the health sector in Zimbabwe? What are the formal/informal roles and mandates of different players? What is the balance between players at different levels of the health system? To what extent is power vested in the hands of specific individuals or groups in relation to the health sector in Zimbabwe? How do different interest groups outside government (e.g. private sector, non-governmental organisations, consumer groups, the media) seek to influence policy? How were these reflected in the adoption, adaption and implementation of RBF? Haw has RBF influenced these roles in turn? | |
Donor roles and coordination | What role have external development partners played in relation to the health system in Zimbabwe? How well do they cooperate and coordinate? Do they always support national priorities? Do you think they have their own political economy incentives to pursue particular approaches? How were these reflected in the adoption, adaption and implementation of RBF? Has RBF influenced these processes in turn? | |
Distribution of resources | Support for reform | Who were the “winners” and “losers” from RBF, at different stages? Who are its key champions? How much political priority does RBF have and why? Who is resisting, and why? |
Ownership structure and financing | How is the sector financed? What is the balance between public and private ownership? How did these feed into the adoption, adaption and implementation of RBF? How has RBF in turn influenced ownership and financing in the sector? | |
Corruption and rent seeking | Is there significant corruption and rent-seeking in the health sector? Where is this most prevalent (e.g. at point of delivery; procurement; allocation of jobs)? Who benefits most from this? How is patronage being used? How were these reflected in the adoption, adaption and implementation of RBF? Has RBF influenced these processes in turn? | |
Service delivery | Who are the primary beneficiaries of service-delivery? Are particular social, regional or ethnic groups included or excluded? How are subsidies provided, and which groups benefit most from these? How were these reflected in the adoption, adaption and implementation of RBF? Has RBF influenced these equity outcomes in turn? | |
Institution-alisation | Recommendations | In order to make RBF effective and sustainable in this context in future, what would you recommend? |