Hi Arun – thank you for these really insightful comments. We definitely agree that everything in governance is so dependent on context (one of the reasons why measurement has been so much harder in this field!) – and that it is not just context related to what is supposed to happen (for ex, decentralization) but also what reality is. We are working to address these differences in the development of these indicators, so that something like “government power” is not just a single number in any case but is built on a mapping of government factors that can tell us something more comprehensive and nuanced about government power. It is a challenge for sure, but a good reminder that indicators that do not allow for differences in context are not going to be useful for moving measurement in the field forward!

So, low resource settings with highly devolved system of public administration (like local, provincial/sub national and federal) may have a particular liking for the rhetoric of words like “devolution,” “autonomy,” “self-sustainability,” and locally managed. But, in practice the devolution of financial powers (functions) may not be consistent with the devolution of structures.

In other words, the financial powers may be highly centralised in an otherwise highly devolved political system. Coupled with this perplexing phenomenon is another phenomenon of accountability for (excellence) in performance. The (health) institutions at the lower levels are increasingly made to be accountable for the performance or the lack thereof in the pretext of having financial autonomy.

The extent of (effective) financial devolution and the breadth/depth of financial autonomy for performance must also make part of measurement of progress in fiscal governance reforms (in general and not only for the health). And, arguably make a better proxy for the political will than other measures.