What do we learn from using Political Economy Analysis in 13 national health and education programmes?

If you’re interested in Thinking and Working Politically, or the use of Political Economy Analysis (PEA) in aid and development, then do please follow the Governance and Development Soapbox, run by the team at Abt. I’ve re-posted quite a few of its blogposts, by Graham Teskey, Lavinia Tyrrel and others, but it also has some excellent working papers and briefing notes.

It’s latest (10 page) briefing note is on ‘Applying Political Economy Thinking to Sector Programming’. Its starting point is a critique often levelled at PEAs – that they are often a one-off exercise (usually by well paid consultants) and a tick box exercise, but the people actually running a programme don’t read them or use them to make decisions.

The paper summarizes how Abt has applied PEA to education and health sector programming in 13 countries in Asia, the Pacific and Africa – another plus, as most such discussions are limited to the relative backwater of aid sector governance programmes, whereas H&E are big money items.

Some findings: Despite the variation between the 13  countries:

Cringe motto but great practice…..

‘three high-level implications of state-level political economy for service delivery in all 13 countries emerged:

i. Decisions regarding the allocation of public resources are often taken for private gain rather than public interest – for example, the diversion of national budget away from health services and towards capital works in an MPs electorate, or the awarding of procurements to provide kick-backs to individuals;

ii. What may appear formally to be functional planning and delivery systems are used informally but deliberately to create rent-seeking opportunities for interest groups. These groups do not have to be elites themselves: rents can be created anywhere in a system where discretion is combined with a lack of accountability (this explains how staff in health posts can sell public drugs for their own gain); and

iii. Given the ‘embeddedness’ of these political economy characteristics, there are no short-term fixes for external partners. All delivery modalities will represent a technical second (or third) best option. Moreover, every country will require its own bespoke solution.

Common themes

1. Basic services (and specific subsectoral issues) are neglected for a reason: All states allocated insufficient national budgets to basic health and education services, to meet the demand of the population. This was particularly pronounced for particular sub-sectors – such as funding to address Neglected Tropical Diseases (NTD), to support teachers to deliver curricula in alternative languages of instruction, or prioritisation of critical Maternal Child Health (MCH) services.

2. Limited accountability, with basic health and education outcomes rarely featuring as a political ‘hot’ issue for citizens or MPs during elections.

3. Pockets of pro-reform: The highest performing countries in terms of health or education outcomes often had a combination of driven bureaucrats coupled with supportive (or non-interfering) ministers, often at both the national and sub-national level…. There was potential in many places to better organise and resource what are already promising pockets of pro-reform individuals and coalitions/networks for education or health reform advocacy.

4. Centre-periphery tensions: In all states, the national government claimed the right to set policy and strategy, while ‘lower’ levels of government typically had the formal responsibility for implementation and monitoring (but without the financial or human resources required).

5. The collective action challenge: ministerial rivalry and infighting over prestige and resources were more common than genuine collaboration.

6. Weak capacities and capabilities: multiple skill shortages at all levels and in all states

7. Procurement and supply chains: In some states, evidence pointed to corruption, nepotism, and the diversion of funds at goods and service procurement points. [In others, wastage born of poor data were more of a problem]

8. Village and community levels: In many cases, the individuals who were working the hardest (e.g. trudging through rain to villages to deliver disease information with no boots or equipment, or teachers turning up to work without having received pay for months on end) were also the most important but weakest link in the interface between the state and its citizens. All too often, frontline education and health workers were expected to perform critical community services, usually with minimal or no recompense, reward or recognition.

Plenty of PEA in here…..

Conclusion and Recommendations:

The theory and practice of PEA can challenge existing orthodoxies in health and education program design and delivery. Some practitioners remain unconvinced of the value of such analysis in health or education programmes, particularly those with a heavy clinical or learning focus. Here the focus is often on direct delivery to meet the immediate needs of those afflicted by certain diseases or struggling to achieve strong learning outcomes in the classroom. Yet such an approach does little to influence the systems and politics which shape the delivery of these services over decades, not just months or years. More effort is needed to find a common language and theoretical framework for clinical, learning, health and education systems and PEA experts.

PEA is an important tool in sector program design, delivery and evaluation, but it is not a panacea. PEAs must be understood in conjunction with other theoretical approaches and problem diagnoses, for example in health this means epidemiological assessments, supply chain analyses, health systems and PFM analyses and approaches to gender and social inclusion.

There’s little point in thinking politically if you can’t work politically. PEAs are often treated as a one-off activity conducted at design, which have little bearing on program delivery and review (selection of partners, theories of change, measurement indicators, activity design, budget allocation and so on). Part of the challenge lies in the PEA assessments themselves (PEAs can become fixated on problem definition, with less thought given to practical recommendations for health practitioners to translate this into activity design and implementation).

Gender, exclusion, and inequality (GESI) need to be considered as central to how PEAs are designed and conducted – and vice-versa. This includes in the framing of key PEA questions, how power is understood, how institutional and actor mapping is undertaken, who leads and participates in the PEA (including whose voices are not reflected in the PEA), and how sense-making and the communication of findings occurs. Abt is currently developing a GESI responsive PEA (GRPEA) guide, which will seek to address these issues.

[I’ll let you know when the GESI guide comes out – could be really useful]

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