Meant for public health professionals, the Chapter explains what is meant by political economy and its relevance to health, why structural reforms in health are frequently influenced and obstructed by political considerations, how political expediency influences priority setting decisions in health that are frequently related to allocation of resources, and what measures can be taken to minimize political obstacles and barriers in favour of evidence-informed decisions. Political economy of health, as a field of study, grew rapidly in the 1970s that sought to explain the disparities in health care access and the socioeconomic differential in health status across society. Health system development, reform and transformation is a social and political intervention. Political economy analysis (PEA) is central to the successful formulation of health policies and plans and for ensuring their effective implementation. PEA can help to identify potential barriers and facilitators for policy and system change. PEA can help to identify potential barriers and facilitators for policy and system change.

This chapter explores the evidence base that informed the work of donors. It examines the analytical work undertaken in developing countries, mostly financed by multilateral and bilateral agencies. Three trajectories in this body of education research can be identified: (i) large-scale surveys showing broad trends and patterns; (ii) randomized controlled trials claiming to show “what works” in education; and (iii) political economy research. I highlight the strengths and limitations of each of these research tracks, examining to what extent studies were able to inform project design or steer mid-course correction to improve learning. The discussion shows how the predominance of one approach blinds practitioners to the specificities and complexities of the two levels (micro and meso) critical for learning. This also displaces much-needed resources for knowledge generation in the areas that impact learning. In sum, the educational ecosystem in a country, which includes numerous institutions at the micro and meso levels interacting and working together to make a school system function, is a black box.