Table 8 Themes and Open Codes of Barriers and Enablers to Uptake, Implementation and Continuation of Co-financing Models
From: Financing intersectoral action for health: a systematic review of co-financing models
Example of Open Codes for Barriers | Sub Categories of Barriers | Theme | Sub-Categories of Enablers | Example of Open Codes for Enablers |
|---|---|---|---|---|
• perceived risk, • ambiguities, • unclear timeframes to realise positive impact, • concerns over likely power shifts, • concerns over expansion of duties without matched increase in capacity, • perceived sense of position threat, • streamlining of functions leading to job loss, • lack of buy-in from actors across levels, • fear of impact on branding and position, • unsupportive public/client groups • Perceived underperformance of programme | Actor resistance due to perceived risk, ambiguities and threats | Conceptual Buy-In | Favourable political climate, client, actor and public support | • Recognition of need for change • effective incentives and perceived value, • limited resource as opportunity |
• upstream-downstream discord-non-aligned prioritisation between administrative levels of government, • lack of consensus in negotiated details, • ambiguous terms, • inequitable funding arrangements, • lack of pre-defined responsibilities, • dissimilar shared purpose (operational, programmatic and of partnership), • (lack of) unity between leads, • ineffective change management, • unclear lines of authority | Unclear terms and unmatched partnership | Model Design, Planning Framing and Implementation | Effective planning | • Specific and outcome focussed framing in design and implementation, • extensive stakeholder consultation, • space for flexibility, • sustainability planning, • external facilitation and mediation |
Context level for implementation | • Actors were positioned to facilitate intersectoral coordination | |||
• limited resources as obstacle, • differential IT infrastructure- hardware/Software, • lack of shared information sources, • turnover of key positions (operational) • hardware and software | Inadequate or incongruent resources | Organizational Resources and Capacity | Matched Partnership | • Matched partner resources - equal size, capacity, financial equity, • decision-making and implementation |
• differences in pay scale, • different operational processes | Differences in human resources and ways of working | Adequate Expertise and Capacity | • Expertise of implementing team, • multidisciplinary capacity, • capacity to offset risk and uncertainties, • ability to be responsive to needs, • stability of key positions | |
• lack of leadership readiness, • no leadership buy in | Leadership | Leadership | • Strong leadership, • Prioritisation from leaders, • low turnover of leadership position | |
• timelines not sufficient to produce impact, • long-term sustainability to continue beyond pilot or single term | Time | Time | • Time to foster relationship and achieve impact | |
• no confidence in partners, • poor relationships, • different work culture/practices/processes, • strained communication, • unmatched prioritisation of co-financing between collaborators | Non-constructive relational and work dynamics | Relational and Organizational Culture | Established positive relational and work dynamics | • Extensive engagements, • effective relationships, • mutual trust, • culture of collaborative work, • history/record of collaborative work and partnership, progressive understanding of each other organization, culture, and practices, • joint-training and knowledge dissemination |
• weak and subjective evidence, • access to data and confidentiality issues, • lack of common culture, record and practice for accountability, • different data reporting requirements | Insufficient result-focussed practices | Evidence, Output Data Monitoring and Evaluation | Set targets | • Creation of interagency performance targets |
Evidence of success | • Demonstrated success of pilot initiatives | |||
• different accounting techniques, • reduced sense of financial flexibility, • rigidity in resource allocation, • rigid line-item accounting, • unanticipated rise in costs, or non-budgeted cost domains, • no matched change in accounting practice, • allocations based on historic trends-not current needs | Unmatched methods and capacity to adapt to needs | Finance and Accounting Practices | Financial control | • shared pre-negotiated control of funds |