The Political Economy Of Universal Health Coverage: The Case Of Health Financing Reform In Kenya

There is growing interest in the political economy of health financing, as universal health coverage (UHC) has become a top global policy priority. While many high-income and middle-income countries have made significant UHC progress, reforms in many low- and middle-income countries (LMICs) have been slow and varied. Achieving UHC requires strong health financing systems.

Health financing research in LMICs follows two strands: one emphasises the technical solutions, and the second examines the political and economic factors. While the former dominates, it often pays limited attention to the political factors shaping health financing decisions. The latter overemphasises the role of political actors and the 'political will' of top-level leadership, often neglecting the broader institutional and ideological factors.

My research contributes to this second strand, analysing the political economy of health financing reform for UHC. Using the case of Kenya, I examine the differential adoption of health financing reform across two episodes of reforms to identify the political drivers that facilitate or hinder the adoption of health financing reforms. The research employs a qualitative comparative case study approach, using key informant interviews (with donors, policymakers, political elites, health financing experts, etc), document analysis, and archival research (media and Hansard reports).
The research will provide theoretical insights into the political economy of health financing in LMICs, particularly in Africa. Findings will inform policymakers, development partners, and scholars in global health by highlighting how political factors shape health financing reforms for UHC.

Paper 1: The political economy of health financing reform for UHC in LMICs: A systematic Review - Submitted to Health Policy and Planning
Paper 2: Political economy of health financing reform: Understanding Kenya's Social Health Insurance (SHI) reform adoption through Kingdon Multiple Streams Theory - Draft to be submitted to Journal of Social Science and Medicine
Paper 3: Zombie ideas: Why do bad policies persist? Analysing persistence of contributory health mechanisms and implications for UHC in LMICs
Paper 4: Health Financing Analysis: Critical analysis of Social Health Insurance reforms in Kenya