Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia
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Over the last decades, universal health coverage (UHC) has been promoted in south-east Asia (SEA), where many countries still need to ensure adequate financial protection to their populations. However, successful health financing reforms involve complex interactions among a range of stakeholders, as well as with context factors, including shocks and crises of different nature. In this article, we examine recent health financing reforms in Nepal, Thailand and Indonesia, using a political economy lens. The objective is to understand whether and how crises can be utilised to progress UHC and to analyse the strategies used by reformers to benefit from potential windows of opportunity.
The findings, which bring out similarities and differences in the roles played by change teams across the settings, highlight the importance of working closely with political leaders and using a wide range of strategies to build coalitions and engage or block opponents. Changing decision rules to block veto points was significant in one case, and all three cases used participation and dialogue strategically to further reforms. More broadly, the links with context emerged as important, with prior conflicts and economic crises creating a sense of urgency about addressing health inequities, while in all countries appeal was made to underlying values to enhance the legitimacy of the reforms.
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Citation
Witter, S., Bertone, M.P., Baral, S. et al. Political economy analysis of health financing reforms in times of crisis: findings from three case studies in south-east Asia. Int J Equity Health 24, 34 (2025). https://doi.org/10.1186/s12939-025-02395-5
Further information
- Case study (2023): Bringing political economy thinking into global health financing policy and practice in fragile and shock-prone settings
- Video presentation: How to Integrate Political Economy into Technical Reform Processes Oriented towards UHC – Watch videos of the presentations and read the slides here.