Background
In a recently published Commentary in Health Policy and Planning, we discuss how the COVID-19 pandemic and its economic consequences have raised questions about the availability, design, implementation, and accountability of external assistance for health. We argue that these questions have made urgent the need for a fundamental rethink of how to conceptualize and implement external assistance such that it better aligns with and strengthens domestic health systems. This in turn is key for external assistance that will enable rather than undermine efforts to sustain the coverage of services that are essential for countries to move closer towards universal health coverage (UHC). While noting opportunities to draw on experiences of countries that have transitioned[1] away from external support we also reflect on the paucity of literature that can inform such a rethink and the need for more research in this area.
Responding to the need for more research, the Alliance for Health Policy and Systems Research, WHO in collaboration with the WHO Health Financing Policy Unit and UHC 2030 is supporting the development of a supplement in Health Policy and Planning on Rethinking External Assistance for Health to be launched in November 2023.
Themes and topics
In line with the issues outlined in the commentary, we invite submissions related to the three thematic areas mentioned below. For each theme, we suggest research questions. However, authors should feel free to address other questions related to the identified thematic areas.
The impact and implications of COVID-19 on external assistance for health and related consequences for national health financing systems
- What shifts has COVID-19 triggered in relation to the availability, focus, and models of external assistance for health in low- and-middle-income countries (LMICs)
- What lessons have emerged from the COVID-19 experience in terms of the structure, content and level of external assistance for health?
- How has external assistance for COVID-19-affected national health financing systems in countries? What are the policy responses that countries have implemented in the face of this impact and what impact have they had?
Sustaining Coverage in the face of transitions from external assistance
- How has external assistance for health been designed and implemented to enable (or undermine) sustained coverage of priority services in the face of transition from external funds? What efforts have been made to increase national ownership and align with national reforms focused on enabling UHC and health security?
- How has external assistance been designed and implemented to optimally complement and enable efficient use of domestic resources? What (if any) public financial management reforms have been spurred by external assistance? What have been the lessons and challenges in strengthening national institutions?
- How have national and sub-national health systems adapted (or not) to maintain coverage of key interventions in the face of reductions in external assistance? What learning, if any, has there been in terms of practices around human resource management, service delivery, supply chain management, information systems and governance arrangements?
- How have declines in external assistance been used (or not) as opportunities to realize efficiency gains with respect to these and other areas?
Repositioning external assistance- current targeting models and improving on them
- What are the limitations of current external assistance models in different country income contexts? How can these best be addressed in the future to meet the challenges of COVID-19, future pandemics and other emerging threats as part of the overall SDG agenda? What differentiated approaches and models are needed for providing external assistance for health based on country context? What are the lessons that emerge from LICs and MICs?
- Where has external assistance been most conducive to strengthening health systems (in terms of enabling system-wide, sustainable changes in policies and regulations, organizational structures, and relationships across the health system building blocks towards UHC)? What has enabled it to contribute to health system strengthening efforts? What have been some of the barriers to it being able to strengthen health systems for delivering on UHC?
- What is the role of power asymmetries among donors and recipients in shaping external assistance for health? How have these been shaped by the legacy of colonialism? How can models of external assistance be improved to address these asymmetries as part of larger efforts to decolonize global health?
- How do interactions between donors, national and sub-national actors influence how external assistance is designed and implemented in federal systems? What are the implications for sustained coverage within countries and differences in coverage across sub-national units?
Types of Submissions
Original research articles and innovation and practice reports are invited. Innovation and practice reports are narratives and/or reflections/experiences from the perspective of policymakers and practitioners operating at the national or sub-national level which focus on innovative approaches to health systems strengthening towards UHC. For original research articles, we are interested in a range of article types. These include mixed-methods research papers that systematically bring together quantitative and qualitative data to describe both what changes in external financing for health have occurred, but also why they have occurred and what responses have taken place. We are also interested in analytical studies of policy processes that explain how and why external assistance policies and practices were designed and implemented as they were, as well as analyses that delve deeper into the challenges presented by current models of external assistance and how these can be addressed. These include analyses that interrogate and challenge the role of power relationships between donors and recipients in shaping external assistance and strategies to address these. We are explicitly not looking for review papers including systematic reviews or scoping reviews. Papers should go beyond describing problems, and given HPP’s focus on applied research, emphasize and analyze evidence to inform effective policy responses.
Submission and Publication Process
Authors are invited to initially submit structured abstracts (of no more than 400 words) no later than June 3rd, 2022 at the link here. These abstracts will be reviewed by the supplement editors with the final selection of abstracts made based on their quality, originality as well as the diversity of issues raised, geographical focus, and methods used.
Selected abstracts will be invited to develop full papers. Authors can expect to be notified of this invitation by July 18th, 2022. Full papers will be due for submission to the journal by January 20th, 2023 with envisaged publication in November 2023. All papers will be subject to Health Policy and Planning’s regular peer review process. We plan to publish approximately 10 papers in the supplement. Authors from all countries are eligible to submit abstracts; however, we aim to ensure that at least 50% of the published papers come from a first author based in a low- and-middle income country. Manuscripts that clear the peer review process but for which space cannot be made for inclusion in the supplement will be treated as routine journal submissions and considered for publication in a regular issue of the journal.
For enquiries at the stage of abstract submission, please contact externalassistance@who.int.
[1] For the purposes of this research programme, we understand ‘transition’, as no longer being eligible to receive grants or highly concessional loans from major global health funders on account of countries having achieved pre-defined income and health thresholds
