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Purchasing is a critical function of health financing which links resources mobilized in the health sector to effective delivery of quality healthcare services. Strategic purchasing therefore can help a country improve financial risk protection for the vulnerable population by making sure that essential services are available at an affordable cost. The Imo state in Nigeria, has implemented a number of reforms in its quest to ensure universal health coverage (UHC), which includes purchasing reforms. In this study, the authors examined the purchasing arrangements and practices in the state’s healthcare system to track its progress towards strategic health purchasing (SHP) committed to UHC. A critical review and analysis of healthcare financing schemes in the state was undertaken. The results shows that healthcare purchasing in Imo state remains mostly passive, with very limited strategic purchasing arrangements. The main challenges stem from the entrenched institutional mechanism of passive purchasing in the government’s health budgets that are derived from general tax revenue, lack of purchaser–provider split, and poor provider payment and performance monitoring mechanisms. The establishment of the social insurance agency represents an opportunity for boosting SHP in the state for enhanced progress towards UHC.
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