Political Economy Analysis Reveals Challenges Facing Primary Health Care in Eastern and Southern Africa

Investments in health management capacity are important, but improving the environment in which managers operate is equally critical to achieving Sustainable Development Goal targets for health. A political economy analysis conducted in Kenya, Malawi, and Uganda revealed that while decentralization should improve PHC, it has been accompanied by thick bureaucracy, underfunded budgets, weak accountability, and insufficient public administration capacity. The emergence of COVID-19 has highlighted these challenges and underscored the need to address the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics.