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Problem: Health systems reflect the socio-economic and political contexts in which they operate, with values central to understanding existing financing arrangements and reform initiatives. Also important are international declarations, for example, the 2030 agenda for sustainable development with the overarching target under goal 3 of achieving universal health coverage (UHC). Reform initiatives to change how health services are financed, including how revenue is raised, resources are pooled and purchasing organised, impact on system performance, often targeting inefficiencies and inequities. In countries that have not yet achieved UHC, the most frequently implemented reforms are to expand coverage of essential services to disadvantaged populations and distribute resources more equitably. Across all countries, other reforms are varied, including to promote strategic purchasing as a means to create incentives aligned with health system goals and objectives and to control costs by priority setting using economic evaluation or other approaches. Health financing reforms inevitably affect a range of stakeholders and alter the distribution of entitlements, responsibilities and resources. Stakeholders that are disadvantaged by a specific reform will resist change and create tensions that policy makers need to manage. This assignment requires you to conduct a critical review of health financing reform initiatives in at least two countries. Comparisons between reform initiatives in the countries should be made, highlighting similarities and differences. The review should describe the reform initiatives in each country and the intended purpose of the reforms including, if applicable, the values embedded in reforms. Any contextual factors relating to these reforms, or pressure on government to initiate change, can also be raised. Following on, political aspects of the reform initiatives should be examined. For example, who are the winners and losers of reform initiatives, and how did the government negotiate with stakeholders to achieve its reform agenda. Additionally, other factors about the political economy of the health financing reform process in countries can be covered. A point of interest may be the extent to which reforms were successful in achieving their purpose (if known), or whether reforms were sustained or alternatively reversed with a change of government.
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