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”
- Commentary: Introduction to the Special Issue on Making Progress on Strategic Health Purchasing in Africa by Agnes Gatome-Munyua and Cheryl Cashin
Framing the Conversation on Strategic Purchasing
- Why is Strategic Health Purchasing Critical for Universal Health Coverage in sub-Saharan Africa? By Agnes Gatome-Munyua, Isidore Sieleunou, Sory Orokia and Cheryl Cashin
- The Strategic Health Purchasing Progress Tracking Framework: A Practical Approach to Describing, Assessing, and Improving Strategic Purchasing for Universal Health Coverage by Cheryl Cashin and Agnes Gatome-Munyua
- Applying the Strategic Health Purchasing Progress Tracking Framework: Lessons from Nine African Countries by Agnes Gatome-Munyua, Cheryl Cashin, Isidore Sieleunou, Edwine Barasa, Freddie Ssengooba, Kabore Issa, Sabine Musange, Osoro Otieno, Suzan Makawia, Christelle Boyi, Eugenia Amporfu, Uchenna Ezenwaka
- Collaborative Learning to Advance Knowledge and Practice of Strategic Health Purchasing in sub-Saharan Africa by Agnes Gatome-Munyua, Charlemagne Tapsoba and Cheryl Cashin
Strategic Purchasing Country Papers
- Strategic Purchasing Arrangements in Uganda and Their Implications for Universal Health Coverage by Elizabeth Ekirapa-Kiracho, Aloysius Ssennyonjo, Richard Ssempala, Chrispus Mayora, Freddie Ssengooba
- The landscape of Strategic Health Purchasing for Universal Health Coverage in Burkina Faso: Insights from Five Major Health Financing Schemes by Joël Arthur Kiendrébéogo, Charlemagne Tapsoba, Yamba Kafando, Issa Kaboré, Orokia Sory, S. Pierre Yaméogo
- Strategic health purchasing in Nigeria: Investigating governance and institutional capacities within the Formal Sector Social Health Insurance Scheme and tax-funded health services in Nigeria by Uchenna Ezenwaka, Agnes Gatome-Munyua, Chikezie Nwankwor, Nkechi Olalere, Nneka Orji, Uchenna Ewelike, Benjamin Uzochukwu, Obinna Onwujekwe
- Strengths and weaknesses of strategic health purchasing for universal health coverage in Rwanda by Stella Umuhoza Matutina, Sabine Musange, Alypio Nyandwi, Parfait Uwaliraye, Regis Hitimana
- Strategic Health Purchasing Progress Mapping: A spotlight on Ghana’s National Health Insurance Scheme by Eugenia Amporfu, Peter Agyei-Baafour, Anthony Edusei, Jacob Novignon, Vivian Addo-Cobbiah
Key Issues on Strategic Purchasing in Sub-Saharan Africa
- The Government Budget: An Overlooked Vehicle for Strategic Health Purchasing by Aloysius Ssennyonjo, Otieno Osoro, Freddie Ssengooba, Chrispus Mayora, Elizabeth Ekirapa, Richard Ssempala and Danielle Bloom
- Is performance-based financing a pathway to strategic purchasing in sub-Saharan Africa? A synthesis of the evidence by Dennis Waithaka, Cheryl Cashin, Edwine Barasa
The Evidence on Strategic Purchasing and Impact on System Improvements
- Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing by Fred Matovu, Agnes Gatome-Munyua and Richard Sebaggala
- The Effects of Health Purchasing Reforms on Equity, Access, Quality of Care, and Financial Protection in Kenya: A narrative review by Evelyn Kabia, Jacob Kazungu, Edwine Barasa
- Strategic Health Purchasing in Nigeria: Investigating governance and institutional capacities within federal tax-funded health schemes and the formal sector social health insurance programme by Obinna Onwujekwe, Chinyere Ojiugo Mbachu, Chinyere Okeke, Uchenna Ezenwaka, Daniel Ogbuabor, Charles Ezenduka
- Can Strategic Health Purchasing Reduce Inefficiency and Corruption in the Health Sector? The Case of Nigeria by Prince Agwu and Obinna Onwujekwe
- SPARC the Change: What the Strategic Purchasing Africa Resource Center Has Learned about Improving Strategic Health Purchasing in Africa by Cheryl Cashin, Nathaniel Otoo, George Kimathi and Danielle Bloom
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