Political economy of budgeting reforms: a comparative analysis of the adoption and implementation of programme-based budgeting in health across seven LMIC countries

Political economy of budgeting reforms: a comparative analysis of the adoption and implementation of programme-based budgeting in health across seven LMIC countries | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 3 December 2025 V1 Latest version Share on Political economy of budgeting reforms: a comparative analysis of the adoption and implementation of programme-based budgeting in health across seven LMIC countries Authors : Maria Paola Bertone [email protected] , Helene Barroy , Susan Sparkes , Lucas Sempé , MyMai Yungrattanachai , and Sophie Witter Authors Info & Affiliations https://doi.org/10.22541/au.176473277.71999658/v1 312 views 148 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Abstract Despite its widespread application in public financial management reforms across low- and middle-income countries, programme-based budgeting (PBB) implementation often remains relative superficial. The technical weaknesses of the reform have been widely documented; however, the political economy dynamics around the introduction and implementation of PBB in the health sector have not been studied. This comparative case study analysis of seven low and middle-income countries (Burkina Faso, Cameroon, Ghana, Kenya, Peru, Philippines, and South Africa) aims to unpack the political economy drivers of PBB reform in the health sector. The study draws from a global literature review, as well as documentary reviews and expert interviews in each of the seven study settings. Findings describe the policy processes relating to PBB introduction and implementation in the health sector, and provide a detailed, comparative stakeholder mapping and political economy analysis. This describes the position of the key actors in relation to PBB reform in health, which is explained by their interests and how PBB reform would impact them, and how they used their power to affect the PBB reform processes in health. Our analysis identifies political dynamics, processes and narratives that can be strategically leveraged to better inform PBB implementation in the health sector. It also underscores how the insights from PEA can help to advance budgeting reforms in the health sector as part of overall health financing reforms in support of UHC agenda in low and middle-income settings, which experience has shown do not lend themselves to technical solutions alone. Supplementary Material File (pea of pbb_main manuscript.docx) Download 196.16 KB Information & Authors Information Version history V1 Version 1 03 December 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords budgeting for health political economy analysis (pea) programme-based budgeting (pbb) public financial management (pfm) universal health coverage (uhc) Authors Affiliations Maria Paola Bertone [email protected] Queen Margaret University Institute for Global Health and Development View all articles by this author Helene Barroy World Health Organization View all articles by this author Susan Sparkes World Health Organization View all articles by this author Lucas Sempé International Initiative for Impact Evaluation (3ie View all articles by this author MyMai Yungrattanachai World Health Organization View all articles by this author Sophie Witter Queen Margaret University Institute for Global Health and Development View all articles by this author Metrics & Citations Metrics Article Usage 312 views 148 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Maria Paola Bertone, Helene Barroy, Susan Sparkes, et al. Political economy of budgeting reforms: a comparative analysis of the adoption and implementation of programme-based budgeting in health across seven LMIC countries. Authorea . 03 December 2025. DOI: https://doi.org/10.22541/au.176473277.71999658/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); Cited by Sophie Witter, Maria Paola Bertone, Lucas Sempé, Quentin Baglione, Hélène Barroy, Justine Hsu, Inke Mathauer, Financial autonomy of facilities providing primary care services in low- and middle-income countries: assessing the evidence to inform the development of a typology and conceptual framework, BMC Health Services Research, 26 , 1, (2025). https://doi.org/10.1186/s12913-025-13863-7 Crossref Loading... View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.176473277.71999658/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fe8ca46999d4193',t:'MTc3OTI1MzM1Ng=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();