Submission ID 130409
| Issue/Objective | As global health financing undergoes structural shifts, low- and middle-income countries face mounting pressure to transition from donor dependence to domestically financed health systems. Yet, prevailing approaches treat this transition as a technical challenge, overlooking the central role of governance, power, and political negotiation. This study advances a novel perspective by conceptualizing evidence not as input to policy, but as a strategic instrument through which actors reshape power and drive financing reforms. |
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| Methodology/Approach | We conducted a longitudinal, process-tracing analysis of Uganda's domestic health financing landscape (2025-2026), drawing on real-time documentation of policy dialogues, technical working groups, budget processes, and multi-stakeholder platforms. These spaces enabled iterative interaction between government, civil society, academia, and development partners, where evidence was actively curated, contested, and deployed to influence fiscal and policy decisions. |
| Results | Findings show that evidence-informed policymaking in Uganda operates through three interlinked mechanisms: (1) agenda-setting power, where evidence reframes fiscal constraints into efficiency and sovereignty narratives ("more health for the money"); (2) coalition-building, where actors align around shared interpretations of data to strengthen advocacy and accountability; and (3) institutional embedding, where evidence is translated into formal processes such as national dialogues, budget frameworks, and emerging financing strategies. These dynamics contributed to measurable shifts, including increased health budget prioritization and strengthened commitments to domestic resource mobilization. |
| Discussion/Conclusion | Achieving health equity in the post-aid era requires institutionalizing "governance of evidence" as a core health system function. Uganda's experience demonstrates how aligning evidence, actors, and political opportunity can transform financing trajectories and offers a replicable model for countries navigating deep uncertainty in global health financing. |
| Presenters and Affiliations | Eric Ssegujja Makerere University School of Public Health Eric Ssegujja Makerere University School of Public Health |
