Collaborative governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector: A synthesis of stakeholder perspectives

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Abstract Background Most low-and middle-income countries have adopted social health insurance schemes. However, the collection of contributions from the large informal sector of these economies poses a significant challenge. Employing an integrated system of contribution collection for all relevant institutions may be cost-effective. This study explores stakeholder perspectives on the collaborative governance of an integrated system for collecting contributions for social health insurance, pension, and taxes from the informal sector in Zambia. Methods We undertook a qualitative case study involving 25 key informants drawn from government ministries and institutions, cooperating partners, non-governmental organizations, and association representatives in the informal sector. Data were analyzed thematically using Emerson’s integrative framework for collaborative governance. Results The main drivers of collaboration include a need for comprehensive policies and legislation to oversee an integrated system, prevent redundancy, reduce costs, and enhance organizational effectiveness. However, challenges such as leadership issues and coordination complexities were identified. Factors affecting principled engagement within the collaborative regime consist of communication gaps, organizational structure disparities, and a lack of common understanding of the informal sector. Additionally, factors influencing shared motivation involve concerns about power, self-interest, trust issues, corruption, and the varying willingness of informal sector groups to contribute. Conclusion This analysis sheds light on the multifaceted landscape of collaborative governance of an integrated system for contribution collection in a low-middle-income setting such as Zambia, providing valuable insights for policymakers and practitioners alike. Enhancing collaboration holds the potential to broaden the scope of social health insurance, a crucial factor in expanding coverage to the large but often excluded informal sector.

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