Strategic purchasing by deliberately directing health funds to priority populations, interventions, and services to ensure equity and efficiency can help countries reduce inequalities and out-of-pocket expenditures thereby improving social health protection. To help countries implement strategic purchasing, the Strategic Purchasing Africa Resource Center developed a framework for tracking strategic purchasing that uses a functional and practical approach to describe, assess, and strengthen purchasing to facilitate policy dialogue within countries.
This framework was applied in nine African countries in East, Central, and West Africa to assess their progress on strategic purchasing. The findings and lessons from the application of the framework in the nine countries include:
All nine countries have fragmented health financing systems, each with distinct purchasing arrangements.
Countries have made some progress in specifying a benefit package that addresses the health needs of the most vulnerable groups and entering into selective contracts with mostly private providers that specify expectations and priorities.
Progress on provider payment and performance monitoring has been limited.
Overall, progress on strategic purchasing has been limited in most of the countries and has not led to large-scale health system improvements. This is due to the persistence of out-of-pocket payments as the main source of health financing and the high degree of fragmentation which limits redistribution of resources and incentivizing providers to improve productivity and quality of care.
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