WASHINGTON, D.C. — Results for Development (R4D) experts have co-authored a new paper in the journal BMJ Global Health that offers real-world lessons for minimizing the effects of fragmentation in primary health care (PHC) financing.
“Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare” explores the drivers of fragmentation and highlights approaches to mitigating the consequences of fragmentation from Argentina, Burkina Faso, Indonesia and Tanzania. It is co-authored by R4D’s Agnes Gatome-Munyua, Gemini Mtei and Cheryl Cashin, with Kara Hanson, Susan Sparkes, Prastuti Soewendo and Pierre Yameogo.
Though PHC has long been recognized in global declarations and prioritized in national health strategies, PHC in many low- and middle-income countries (LMICs) faces chronic resource challenges and funding constraints. Inefficient and rigid funding flows, whether through new schemes or external donors, can exacerbate financing fragmentation and erode quality of care and public trust.
“Fragmentation in financing for PHC not only creates inefficiency, it reduces the power of other important health financing levers like strategic purchasing,” R4D Managing Director and paper co-author Cheryl Cashin said. “Our paper provides a call to action for governments and development partners to consider how their policies and investments can mitigate fragmentation and avoid exacerbating it.”
In addition to examples of how countries are reducing the effects of fragmentation in PHC financing and a vision of an ideal long-term PHC setting, the paper offers practical entry points and steps that may not require significant organizational changes. Harmonizing or unifying purchasing functions appears as a common theme across several countries’ efforts.
The article distills its insights into four key lessons applicable to many LMICs:
- Avoid new schemes or funding flows that bypass government systems
- Actively manage the political economy that worsens and entrenches fragmentation
- Use strategic purchasing as an entry point to defragment funding flows to PHC
- Defragmenting a small part of the system can be an important catalyst to drive more efficient PHC financing
The paper’s authors also posit these lessons “provide a clear message to donors and implementing partners who should be aware of the potential harm created by new programmes that worsen fragmentation and to national governments that it is possible to direct external resources through domestic systems to national priorities.”
Additional co-authors on the paper include Susan Sparkes of the World Health Organization; Martin Sabignoso, a consultant in Buenos Aires; Prastuti Soewondo of Indonesia’s Ministry of Health; Pierre Yameogo a consultant in Burkina Faso; and Kara Hanson from the London School of Hygiene and Tropical Medicine.
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About R4D
Results for Development (R4D) is a leading nonprofit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, lasting outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and stakeholder input. We also support them to engage in learning to adapt, iterate and improve the efficacy of programs. At the same time, we are working to strengthen global, regional and country ecosystems that support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org
