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Ownership of health financing policies in low-income countries: a journey with more than one pathway
  1. Joël Arthur Kiendrébéogo1,2,
  2. Bruno Meessen3
  1. 1 Department of Public Health, University Joseph Ki-Zerbo, Health Sciences Training and Research Unit, Ouagadougou, Kadiogo, Burkina Faso
  2. 2 Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
  3. 3 Public Health, Collective Horizon, Lier, Belgium
  1. Correspondence to Dr Joël Arthur Kiendrébéogo; jkiendre{at}

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Summary box

  • Ownership of development policies in low-income countries (LICs) remains a topical and sensitive issue as it actually questions countries genuine capacity to successfully lead and sustain policies in the long run.

  • Health financing in LICs is at the crossroad of many of the tensions created by aid assistance—central to debates is the potential noxious role of external actors that could preclude country ownership.

  • As many LICs continue to need external financial assistance for many more years, it is important to understand how country ownership emerge and how external actors can contribute to this process.

  • Based on our hands-on experience, we argue that there is more than one pathway, but any effective and sustained health financing policy requires critical thinking, sound knowledge, sharing of experiences and learning, attention to political economy issues and broad stakeholder support.


There is broad international consensus that weak governmental ownership can compromise the long-term sustainability of development policies in low-income countries (LICs).1 Ownership has thus become a cornerstone of official development assistance, as evidenced by the prominent place it occupies in international resolutions such as the Paris Declaration (2005), the Accra Agenda for Action (2008) and the Busan Partnership for Effective Development Cooperation (2011). Despite this strong signal, coming from both donors and ‘recipient’ countries, problems persist, especially in Africa.2 3

Ownership is an elusive concept. The Paris Declaration attempted to assess it by the ‘number of countries with national operational development strategies that have clear strategic priorities linked to a medium-term expenditure framework and reflected in annual budgets’; but this indicator proved disappointing.4 Ownership can be approached through different perspectives (eg, ‘governmental ownership’, ‘country ownership’ or ‘democratic ownership’).5 In this commentary, we will focus on ‘country ownership’ of health financing policies which, unlike ‘governmental ownership’, is much broader as it also …

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