Measuring country ownership and its relationship to health outcomes: the case of Liberia Public Deposited

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  • March 22, 2019
  • Watson-Grant, Stephanie
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • The concept of country ownership, in the international development aid context is not a new one; it is an essential international development aid component. The structure of development aid assumes a relationship between donor and recipient with the intention of creating goods or services to improve the socio-economic situation in a recipient country. But while country ownership's value is assumed to be beneficial, country ownership's effect is unknown. There is no universally accepted definition, and secondly, no systematic measurement of the concept has been developed. The study aims are: 1) develop a measure of country ownership test if the performance based financing (PBF) system implemented by the Ministry of Health and Social Welfare, and supported by the US Government, can be referred to as `country owned'; 2) assess if health outcomes have improved in Liberia; 3) determine intervening variables that could test a connection between country ownership and health outcomes; and 4) develop a plan for change. This study used a mixed methods approach, first the concept of country ownership was defined, then country ownership of the PBF system in Liberia was measured. Second, secondary data analysis was done to determine if health outcomes have improved. Third, a qualitative assessment was done to suggest intervening variables that could be used to detect a connection between country owned PBF process and improved health outcomes. Therefore, the methodological approach is aligned to the aims of the study. The study's key findings are the PBF scheme in Liberia can be referred to as being country owned; health outcomes examined have not improved and variables for detecting a connection between a country-owned PBF scheme and health outcomes are already being measured within the context of the country ownership of the PBF scheme, so essentially there are no intervening variables. The plan for change includes specific policy recommendations to improve the ownership of the PBF process for Liberian donors and recipients. The recommendations are grounded in the leadership principle of power and influence, which examines power relationships and processes of influence towards achieving effective outcomes and is framed around Kotter's Steps for Transformational Change.
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  • Greene, Sandra
  • Doctor of Public Health
Graduation year
  • 2014

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