Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad

BMC Health Services Research, Jul 2016

Background Harmonisation is a key principle of the Paris Declaration. The Universal Health Coverage (UHC) Partnership, an initiative of the European Union, the Government of Luxembourg and the World Health Organization, supported health policy dialogues between 2012 and 2015 in identified countries in the WHO African Region. The UHC Partnership has amongst its key objectives to strengthen national health policy development. In Guinea and Chad, policy dialogue focused on elaborating the national health plan and other key documents. This study is an analytical reflection inspired by realist evaluative approaches to understand whether policy dialogue led to improved harmonisation amongst health actors in Guinea and Chad, and if so, how and why. Methods Interviews were conducted in Guinea and Chad with key informants at the national and sub-national government levels, civil society, and development partners. A review of relevant policy documents and reports was added to data collection to construct a full picture of the policy dialogue process. Context-mechanism-outcome configurations were used as the realist framework to guide the analysis on how participants’ understanding of what policy dialogue was and the way the policy dialogue process unfolded led to improved harmonisation. Results Improved harmonisation as a result of policy dialogue was perceived to be stronger in Guinea than in Chad. While in both countries the participants held a shared view of what policy dialogue was and what it could achieve, and both policy dialogue processes were considered to be well implemented (i.e., well-facilitated, evidence-based, participatory, and consisted of recurring meetings and activities), certain contextual factors in Chad tempered the view of harmonisation as having improved. These were the pre-existence of dialogic policy processes that had exposed the actors to the potential that policy dialogue could have; a focus on elaborating provincial level strategies, which gave the sense that the process was more bottom-up; and the perception that there were acute resource constraints, which conditioned partners’ interactions. Conclusions Policy dialogue improves harmonisation in terms of fostering information exchange amongst partners; however, it does not appear to influence the operational procedures of the actors. This has implications for aid effectiveness.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.biomedcentral.com/content/pdf/s12913-016-1458-7.pdf

Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad

Kwamie and Nabyonga-Orem BMC Health Services Research Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad Aku Kwamie 0 Juliet Nabyonga-Orem 1 0 Ghana Health Service, Research and Development Division , Private Mail Bag, Ministries, Accra , Ghana 1 Health Systems and Services Cluster, World Health Organization Regional Office for Africa , B.P. 06 Brazzaville , Congo Background: Harmonisation is a key principle of the Paris Declaration. The Universal Health Coverage (UHC) Partnership, an initiative of the European Union, the Government of Luxembourg and the World Health Organization, supported health policy dialogues between 2012 and 2015 in identified countries in the WHO African Region. The UHC Partnership has amongst its key objectives to strengthen national health policy development. In Guinea and Chad, policy dialogue focused on elaborating the national health plan and other key documents. This study is an analytical reflection inspired by realist evaluative approaches to understand whether policy dialogue led to improved harmonisation amongst health actors in Guinea and Chad, and if so, how and why. Methods: Interviews were conducted in Guinea and Chad with key informants at the national and sub-national government levels, civil society, and development partners. A review of relevant policy documents and reports was added to data collection to construct a full picture of the policy dialogue process. Context-mechanism-outcome configurations were used as the realist framework to guide the analysis on how participants' understanding of what policy dialogue was and the way the policy dialogue process unfolded led to improved harmonisation. Results: Improved harmonisation as a result of policy dialogue was perceived to be stronger in Guinea than in Chad. While in both countries the participants held a shared view of what policy dialogue was and what it could achieve, and both policy dialogue processes were considered to be well implemented (i.e., well-facilitated, evidence-based, participatory, and consisted of recurring meetings and activities), certain contextual factors in Chad tempered the view of harmonisation as having improved. These were the pre-existence of dialogic policy processes that had exposed the actors to the potential that policy dialogue could have; a focus on elaborating provincial level strategies, which gave the sense that the process was more bottom-up; and the perception that there were acute resource constraints, which conditioned partners' interactions. Conclusions: Policy dialogue improves harmonisation in terms of fostering information exchange amongst partners; however, it does not appear to influence the operational procedures of the actors. This has implications for aid effectiveness. Policy dialogue; Harmonisation; Alignment; Guinea; Chad Background Harmonisation and policy dialogue The Paris Declaration outlines the commitments of donor partners and country governments to improve aid effectiveness. Harmonisation, here defined as “harmonised actions, transparency and collective effectiveness; common arrangements and simplified donor procedures; complementary division of labour; and incentivised collaboration” [ 1 ], is a key principle of the Paris Declaration. Alignment, another key Paris Declaration principle, is defined as “donor overall support based on partner country national development strategies, institutions and procedures; donor alignment with partner strategies; use of strengthened country systems, and partner countries strengthening their development capacities; public financial management capacities with the support of donors; and untied aid” [ 1 ]. Recently, the International Health Partnership (IHP+), a group of donor agencies, governments and civil society organisations committed to operationalising the international principles for development cooperation in the health sector, identified seven areas for action in applying the Paris Declaration principles to health sector development. These are (1) providing well-coordinated technical assistance, (2) supporting South–South and triangular cooperation, (3) using one information and accountability platform, (4) harmonising with and aligning to national procurement and supply systems, (5) harmonising and aligning national financial management systems, (6) recording all funds for health in the national budget, and (7) supporting a single national health strategy [ 2 ]. In 2012 the Government of Luxembourg entered into a partnership with the World Health Organization (WHO) to build country capacities in 13 countries in the WHO African Region to achieve health sector results, working towards universal health coverage (UHC). This was in line with harmonisation of health aid in Europe and part of a larger European Union-WHO partnership (referred to as the UHC Partnership) to strengthen national health policy development and, where appropriate, aid effectiveness. The emphas (...truncated)


This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/s12913-016-1458-7.pdf

Aku Kwamie, Juliet Nabyonga-Orem. Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad, BMC Health Services Research, 2016, pp. S222, 16, DOI: 10.1186/s12913-016-1458-7