In mixed or plural health systems, the growing diversity of stakeholders in service provision, financing, and governance is often expected to improve access to healthcare, system efficiency, and the responsiveness and quality of services. However, in practice, the reverse is often true due to inadequate public funding, ineffective regulation of the private sector, and opaque, disjointed governance processes. This is particularly damaging for Low and Middle-Income Countries (LMICs) with large coverage gaps. Nonetheless, insufficient coordination and resulting dysfunction is increasingly relevant in many High-Income Countries (HICs), where universal health coverage is often legally guaranteed, but effective utilisation of services is hampered by growing and inadequately managed plurality.
The literature frequently advocates for strengthening coordination mechanisms to align diverse actors with the goal of effective universal health coverage. These mechanisms include community participation in governance; state-provider contracts; streamlined, enforceable regulation; technology-enhanced monitoring and evaluation systems; and the provision of information and other support services to promote transparency and reduce out-of-pocket expenditure, especially among vulnerable populations.
However, health system reform takes place in complex historical, political, legal and social contexts where the needs of different populations, the characteristics and endowments of public, private, and civil society actors, and the dynamic relationships between them differ significantly. Little is known empirically about how the effectiveness of potential coordination mechanisms is mediated by these factors, or about how different configurations of coordination mechanisms interact in specific places to influence different dimensions of access, equity, and quality. Understanding how coordination mechanisms function in practice thus requires examining their interaction with specific institutional and relational contexts at multiple levels. This can generate insight about governance patterns that either facilitate or hinder coordination and government stewardship.
The objective of this panel is therefore to explore the use of coordination mechanisms in plural health systems in both HICs and LMICs, and how features of implementation and context combine to shape people’s experiences of healthcare, whether positively or negatively. We invite papers addressing these issues—particularly comparative studies focusing on different combinations of coordination mechanisms or on their effects in various local or national health systems.
