Political Economy of Budgeting Reforms: A Comparative Analysis of the Adoption and Implementation of Programme-Based Budgeting in Health Across Seven LMIC Countries.

Abstract

Despite its widespread application in public financial management reforms across low- and middle-income countries, programme-based budgeting (PBB) implementation often remains relatively superficial. The technical weaknesses of the reform have been widely documented; however, the political economy dynamics around the introduction and implementation of PBB in the health sector have not been studied. This comparative case study analysis of seven low and middle-income countries (Burkina Faso, Cameroon, Ghana, Kenya, Peru, Philippines, and South Africa) aims to unpack the political economy drivers of PBB reform in the health sector. The study draws from a global literature review, as well as documentary reviews and expert interviews in each of the seven study settings. Findings describe the policy processes relating to PBB introduction and implementation in the health sector, and provide a detailed, comparative stakeholder analysis and political economy analysis. This describes the position of the key actors in relation to PBB reform in health, which is explained by their interests and how PBB reform would impact them, and how they used their power to affect the PBB policy processes in health. Our analysis identifies political dynamics, processes and narratives that can be strategically leveraged to better inform PBB implementation in the health sector. It also underscores how the insights from political economy analysis can help to advance budgeting reforms in the health sector as part of overall health financing reforms in support of UHC agenda in low and middle-income settings, which experience has shown do not lend themselves to technical solutions alone.