A One on One Interview with Dr Aloysius Ssennyonjo – (SPEED Project Manager) Reflecting on the Expert Consultation Workshop on the Political Economy of UHC Financing Reforms held on 2-3rd July, Barcelona- Spain.

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What are your names and position at SPEED?

I am Dr Aloysius Ssennyonjo and work as the Project Manager for SPEED. I am also a Research Fellow in the Department of Health Policy, Planning and Management, Makerere University School of Public Health (MakSPH).

You represented SPEED at a WHO workshop in Barcelona in July 2018, what was it all about?

It was a WHO Expert Consultation Workshop on the political economy of health financing reforms held in Barcelona between 2nd -3rd of July 2018.  This was an invitation by WHO following the World Health Assembly presentation  made by SPEED at the side event organised by EU, and Ministers of health for Uganda and Ethiopia. The meeting was convened within the understanding that many countries are taking on health financing reforms towards Universal health coverage (UHC) with suboptimal attention to the political economy opportunities and constraints that characterise these reform processes. The meeting was attended by 23 experts in the field of health systems, health financing and political economy. These experts included policy makers (from Mexico, Chile, Iran, and Argentina), WHO Geneva and Regional Offices, academia (Harvard University, New York University, SPEED Project-Makerere University) and independent consultants.

Dr Aloysius Ssennyonjo at the entrance of the workshop venue

What were its objectives and theme?

The meeting had two main objectives;  

  • To critically analyse how political economy analysis and strategies informed by policy economy perspectives can be incorporated into health financing reforms.
  • To review a draft framework developed by a team at WHO and Harvard University, look at its utility, implications and seeing how it can be better developed.

The workshop employed plenary and group discussions.  A draft framework on political economy of health financing reform was assessed. Experts commented on the different elements that had been proposed therein and generated areas for adjustment.

Who were the organisers of the workshops?

The meeting was organised by WHO Department of Health Systems Governance and Financing in collaboration with experts from Harvard University School of Public Health.

What in particular did you present about?

In general, I emphasised the role of ideas, frameworks and how they can greatly influence the direction of health reforms. I also emphasised that the political economy perspective does not only consider constraints but it also presents opportunities. Within these realities, actors (such as individuals, groups or organisations) have a room to manoeuvre through their context by drawing on their knowledge, networks, and power to influence policy processes. In that way, these are very important aspects to think about while discussing political economy of any policy reform process. The consideration of the politics of reforms beyond the technical aspects is critical. The need to pay attention to interests was also emphasised.

How was the meeting related to the goal of attaining UHC and SPEED’s objectives?

This meeting focused on health financing reforms towards attaining UHC. The discourse on UHC has evolved overtime from an initially narrow focus on introducing national health insurance systems. Current discussions cover a wide of health financing and other systems reforms.  However, irrespective of the specific reform, all these reforms have inherent political implications if they are to be undertaken.  Most often these reforms have to go through a process of contestation and negotiation. They have winners and losers. Very importantly for the case of Uganda where the proposal to establish a National Health Insurance that has  been considered delayed by some actors in the health sector, the political economy perspective provides plausible explanations for this “delayed” process. For instance, the Employers’ Association and private investors have reportedly expressed concerns about the reform making the cost of employment expensive because of additional deductions for insurance premiums. In brief, understanding the political economy issues surrounding proposed policies should be considered critical in addition to the technical aspects.

In regard to SPEED’s objectives, SPEED aims at engaging and influencing policy makers with contextually adapted evidence. This evidence should consider political economy realities. The invitation to this workshop demonstrated the fact that the SPEED project has been able to penetrate strategic platforms at international level. The meeting also attests to the acknowledgement of SPEED’s work at such high level arena. It was a great opportunity for us to meet other experts in this field of health financing and political economy.  The workshop also spoke to kind of work that we need to continue undertaking if SPEED is to successfully influence emerging policy discussions.

At a personal level, the meeting enhanced my understanding of the political economy perspective that guiding my PhD study.

How can SPEED benefit from such workshops at national and global level in future?

What is important is to have the ears on ground to anticipate and understand what is on the horizon. It is encouraging to see many of SPEED team members receiving invitations to such fora. SPEED team has built a brand that can be associated with quality and value. We have placed ourselves in a strategic position where our contributions to the UHC discussions can be  solicited. Whenever we are invited, SPEED team should ensure to show up and make substantial contributions reflecting who we are and what we stand for. At the national level, SPEED should support those with the mandate to spearhead the processes of mobilising stakeholder contributions to the national UHC efforts. There are opportunities to continue convening such fora but we need to leverage the networks we have at the global level. In terms of preparation, the SPEED team needs to be always prepared to respond whenever called upon.  Fundamentally we need to continue being both proactive and responsive to stakeholder needs.

What other information would you wish to share about this workshop?

It was a great opportunity for me and SPEED in particular to meet with people from different background and expertise. I also had an opportunity to visit Barcelona.  It is the beautiful city!

I was also able to meet up with Mr. Javier Burgos – the EU expert on communication who had visited our project in May this year. We were able to catch up on progress in implementing the Projects’ visibility strategy.

Mr. Javier and Dr. Aloysius sharing a light moment in Barcelona
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