Interest Groups and Health Facility Regulation – Future Directions for Health Policy and Systems Research; Comment on “What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya’s Health Facility Inspection Reforms”

Document Type : Commentary


1 School of Population and Public Health, School of Public Policy and Global Affairs, University of British Columbia, Vancouver, BC, Canada

2 The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

3 The George Institute for Global Health India, New Delhi, India


In their paper, Tama and colleagues observe that one key challenge in a pilot, multi-component intervention to strengthen health facility regulation was the reaction from health facility owners and providers to regulatory processes. In this commentary, we propose that future research and action on health facility regulation in low- and middleincome countries (LMICs) contexts adopt an explicit focus on addressing the role of interests and interest groups in health systems ‘hardware’ and ‘software.’ Research on policy processes in LMICs consist of fewer investigations into the political economy of national or sub-national interest groups, such as physician associations or associations of health facility owners. A growing body of literature explores supply-side and demand-side interest groups, power relations within and between these stakeholders, and their advocacy approaches within LMIC health sector policy processes. We posit that such analyses will also help identify facilitators and challenges to implementation and scaleup of similar reforms to health facility regulation.


  1. Tama E, Khayoni I, Goodman C, et al. What lies behind successful regulation? A qualitative evaluation of pilot implementation of Kenya's health facility inspection reforms. Int J Health Policy Manag. 2021;11(9):1852-1862. doi:34172/ijhpm.2021.90
  2. Bloom G, Henson S, Peters DH. Innovation in regulation of rapidly changing health markets. Global Health. 2014;10:53. doi:1186/1744-8603-10-53
  3. Gilson L, Orgill M, Shroff Z. A Health Policy Analysis Reader: The Politics of Policy Change in Low- and Middle-Income Countries. World Health Organization; 2018.
  4. Gilson L, Erasmus E, Borghi J, Macha J, Kamuzora P, Mtei G. Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project. Health Policy Plan. 2012;27 Suppl 1:i64-76. doi:1093/heapol/czs007
  5. Yoho J. The evolution of a better definition of “interest group” and its synonyms. Soc Sci J. 1998;35(2):231-243. doi:1016/S0362-3319(98)90042-8
  6. Laugesen MJ. How the American Medical Association's rent-seeking strategy compensated for its loss of members. J Health Polit Policy Law. 2019;44(1):67-85. doi:1215/03616878-7206731
  7. Reich MR. The politics of health sector reform in developing countries: three cases of pharmaceutical policy. Health Policy. 1995;32(1-3):47-77. doi:1016/0168-8510(95)00728-b
  8. Dal Bó E. Regulatory capture: a review. Oxf Rev Econ Policy. 2006;22(2):203-225. doi:1093/oxrep/grj013
  9. Khan M, Rahman-Shepherd A, Bory S, et al. How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan. BMJ Glob Health. 2022;7(5):e008596. doi:1136/bmjgh-2022-008596
  10. Mishra A, Elias MA, Sriram V. A draconian law: examining the navigation of coalition politics and policy reform by health provider associations in Karnataka, India. J Health Polit Policy Law. 2021;46(4):703-730. doi:1215/03616878-8970895
  11. Koon AD. When doctors strike: making sense of professional organizing in Kenya. J Health Polit Policy Law. 2021;46(4):653-676. doi:1215/03616878-8970867
  12. Hernández A, Ruano AL, Hurtig AK, Goicolea I, San Sebastián M, Flores W. Pathways to accountability in rural Guatemala: a qualitative comparative analysis of citizen-led initiatives for the right to health of indigenous populations. World Dev. 2019;113:392-401. doi:1016/j.worlddev.2018.09.020
  13. Putturaj M, Krumeich A, Nuggehalli Srinivas P, Engel N, Criel B, Van Belle S. Crying baby gets the milk? The governmentality of grievance redressal for patient rights violations in Karnataka, India. BMJ Glob Health. 2022;7(5):e008626. doi:1136/bmjgh-2022-008626
  14. Baez Carmago C, Koechlin L. Informal Governance: Comparative Perspectives on Co-optation, Control and Camouflage in Rwanda, Tanzania and Uganda. International Development Policy. 2018;10:78-100. doi:4000/poldev.2646
  15. Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F, Bennett S. Building the field of health policy and systems research: framing the questions. PLoS Med. 2011;8(8):e1001073. doi:1371/journal.pmed.1001073