Objective In fragile and conflict affected settings (FCAS) such as South Sudan, where health needs are immense, resources are scarce, health infrastructure is rudimentary or damaged, and government stewardship is weak, adequate health intervention priority-setting is especially important. There is a scarcity of research examining priority-setting in FCAS and the related political economy. Yet, capturing these dynamics is important to develop context-specific guidance for priority-setting. The objective of this study is to analyze the priority-setting practices in the Health Pooled Fund (HPF) of South Sudan using a political economy perspective.
Methods A mixed methods study was conducted combining document review, 30 stakeholder interviews, and a quantitative assessment of service delivery. An adapted version of the Walt and Gilson policy analysis triangle guided the study’s design and analysis.
Results Priority-setting in the context of HPF takes place throughout program design, implementing partner (IP) contract negotiation, and implementation of the service package. The National Basic Package does not provide adequate guidance because it is too expansive and unrealistic given financial and health system constraints. Furthermore, power asymmetries between actors are pronounced. At the local level, IPs must manage the competing interests of the HPF program and local health authorities as well as challenging contextual factors, including conflict and shortages of skilled health workers, which eventually affect service provision. The resulting priority-setting process remains implicit, scarcely documented, and primarily driven by donors’ interests.
Conclusion This study highlights power asymmetries between donors and national health authorities within a FCAS context, which drive a priority-setting process that is dominated by donor agendas and leave little room for government ownership. These findings emphasize the importance of paying attention to the influence of stakeholders and their interests on the priority-setting process in FCAS. Ultimately, the process of contracting out services is particularly political and requires guidance.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.