Largest body of strategic purchasing research from the African continent

April 28, 2022   |   Benin, Burkina Faso, Cameroon, Tanzania, Uganda

WASHINGTON, D.C. — The Health Systems and Reform (HSR) journal recently published a special issue on “Making Progress on Strategic Health Purchasing in Africa.” This issue will include 17 papers — in the form of commentaries, policy reports and articles — by 43 experts (41 of whom are from African academic institutions, think tanks, and policy agencies) released in four sets.

This special issue was spearheaded by R4D as the core technical partner of the Strategic Purchasing Africa Resource Center (SPARC), a resource hub that aims to strengthen strategic purchasing expertise in sub-Saharan Africa. R4D initially incubated SPARC, and SPARC is now led by Amref Health Africa.

Strategic purchasing is about which health services should be prioritized for public funding, from which providers, and how much providers should be paid to deliver these services. Strategic purchasing enables policymakers to direct health funds to priority populations and services, and to create incentives to health providers aligned with population health needs. It’s widely recognized as a critical lever for facilitating progress on universal health coverage.

“Strategic purchasing is being recognized in Africa as a means to use limited resources better, but the context specific evidence has been limited so far,” said Agnes Gatome-Munyua, M.P.H., associate director at R4D and contributor to the HSR special issue. “It is widely accepted that more public funding is needed to expand access to health services and reduce out-of-pocket payments, but the ability to raise public resources for health in sub-Saharan Africa is limited. At the same time, greater health spending doesn’t always translate into better health outcomes. That’s where strategic purchasing comes in. We’re excited to share this body of research to add to a growing area of work and expertise on the continent around strategic purchasing.”

Before now, evidence on strategic purchasing from Africa has been limited to mostly examining performance-based financing (PBF) schemes, which are often limited in scope, or from Ghana, Kenya, Nigeria, and Rwanda, and focused on insurance-based systems. The special issue offers more varied examples, on different health financing arrangements from countries such as Benin, Burkina Faso,  Cameroon, Tanzania and Uganda. These papers show how each country approaches strategic purchasing differently, and that progress can be made in any health system context.

Dr. Cheryl Cashin, a managing director at R4D and contributor to the HSR special issue, added: “This special issue of the Health Systems and Reform journal spotlights the appetite for more strategic health purchasing evidence that countries can learn from and adapt for their own contexts. It also highlights the deep bench of African experts who have been working to implement and refine strategic purchasing functions in their countries and grow the evidence base through collaborative learning — when groups of learners work together to solve a problem, complete a task, and create new knowledge.”

To read the latest papers, see the table below. We will update the table with links to the papers after they’re published. Ms. Gatome-Munyua and Dr. Cashin also authored an introductory blog to this series, which provides a useful overview. Read it now.

Contents of The Health Systems and Reform (HSR) special issue on “Making Progress on Strategic Health Purchasing in Africa”


Framing the Conversation on Strategic Purchasing

Policy Reports

Strategic Purchasing Country Papers


Key Issues on Strategic Purchasing in Sub-Saharan Africa


The Evidence on Strategic Purchasing and Impact on System Improvements




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