School of Public Health, Makerere University.
Ministry of Health, Kampala Uganda, Hanoi, Uganda.
Glob Health Action. 2021 Jan 1;14(1):1948672. doi: 10.1080/16549716.2021.1948672.
Results-based financing initiatives have been implemented in many countries as stand-alone projects but with little integration into national health systems. Results-based financing became more prominent in Uganda's health policy agenda in 2014-2015 in the context of the policy imperative to finance universal health coverage.
To explore plausible explanations for the increased policy interest in the scale-up of results-based financing in Uganda.
In this qualitative study, information was collected through key informant interviews, consultative meetings (2014 and 2015) and document reviews about agenda-setting processes. The conceptual framework for the analysis was derived from the work of Sabatier, Kingdon and Stone.
Four alternative policy arguments can explain the scale-up of results-based financing in Uganda. They are: 1) external funding opportunities tied to results-based financing create incentives for adopting policies and plans; 2) increased expertise by Ministry of Health officials in the implementation of results-based financing schemes helps frame capacity accumulation arguments; 3) the national ownership argument is supported by increased desire for alignment and fit between results-based financing structures and legitimate institutions that manage the health system; and 4) the health systems argument is backed by evidence of the levers and constraints needed for sustainable performance. Shortages in medicines and workforce are key examples. Overall, the external funding argument was the most compelling.
The different explanations illustrate the strengths and the vulnerability of the results-based financing policy agenda in Uganda. In the short term, donor aid has been the main factor shifting the policy agenda in favour of results-based financing. The high cost of results-based financing is likely to slow implementation. If results-based financing is to find a good fit within the Ugandan health system, and other similar settings, then policy and action are needed to improve system readiness.
成果融资倡议已在许多国家作为独立项目实施，但与国家卫生系统的融合程度较低。在 2014-2015 年，为实现全民健康覆盖的政策要求，成果融资在乌干达卫生政策议程中变得更加突出。
探讨乌干达加大力度推广成果融资的政策兴趣增加的可能原因。
在这项定性研究中，通过关键知情人访谈、协商会议（2014 年和 2015 年）以及关于议程设定过程的文件审查收集信息。分析的概念框架源自萨巴蒂尔、金登和斯通的工作。
有四个替代政策论点可以解释乌干达成果融资的扩大规模。它们是：1）与成果融资挂钩的外部资金机会为采用政策和计划创造了激励；2）卫生部官员在实施成果融资计划方面的专业知识增加有助于构建能力积累论点；3）国家所有权论点得到了增强，因为成果融资结构与管理卫生系统的合法机构之间更加一致和契合；4）卫生系统论点得到了可持续绩效所需的杠杆和约束的证据支持。药品和劳动力短缺是关键例子。总体而言，外部资金论点最具说服力。
这些不同的解释说明了乌干达成果融资政策议程的优势和脆弱性。在短期内，捐助者援助一直是推动有利于成果融资的政策议程的主要因素。成果融资的高成本可能会减缓实施速度。如果成果融资要在乌干达卫生系统和其他类似环境中找到良好的契合度，那么就需要政策和行动来改善系统准备情况。
