Paper short abstract:

The paper provides a framework for defining and explaining variations in reform dynamics across sub-pilllars of social-protection, and applies this framework to the Kenyan case focussing on cash transfer and social health protection reforms (process tracing approach with primary and secondary data).

Paper long abstract:

Social protection reforms involve comprehensive processes of institutional change. The dynamics differ not only across but also within countries across social protection pillars. In order to develop integrated national social protection systems it is important to move away from an isolated view of single instruments towards a comparative understanding of reform dynamics across different sub-policy areas. The case of Kenya is one example for multiple institutional trajectories within a country: Whereas cash transfer reforms follow a pattern of cumulative incremental change, social health protection reforms reflect patterns of non-cumulative change including blocked reforms and reform reversals.

Being embedded within comparative institutional analysis the paper aims at (1) providing a systematic framework for defining and explaining variations in reform dynamics, and (2) applying this framework to the Kenyan case. The empirical methodology employs a process tracing approach including primary and secondary data.

The analysis suggests that firstly, stronger conflicting interests on social health insurance compared to cash transfers or fee waivers contributed to the observed differences in reform dynamics. Secondly, differences in information structures across domains facilitated the introduction of cash transfers and fee waivers, while providing additional impediments to social health insurance. Thirdly, pre-existing institutions within the domains induced stronger barriers to change for social health protection by shaping conflicting interests. Fourthly, a non-stationary reform context provided focal points facilitating coordination on programs targeted at specific vulnerable groups for defined benefits during early stages of the reform process, but supplies focal points supporting systemic approaches during more recent stages.