Chronic conditions, both noncommunicable and infectious, are driving a surge in premature morbidity and mortality, particularly in low- and middle-income countries (LMICs). Ensuring high-quality care for individuals living with these conditions is critical for health system effectiveness and patient well-being. This WHO Center for Health Development study explores how purchasing arrangements—the mechanisms through which financial resources are allocated from purchasers, such as ministries of health or insurance funds, to healthcare providers—can influence the delivery of quality chronic care. By shaping incentives, information flows, and resource distribution, purchasing arrangements have the potential to improve service quality, though guidance on their effective use in LMICs remains limited.
The study combines a systematic literature review with a Delphi survey of 49 international experts to identify the key dimensions and determinants of quality chronic care, including effectiveness, accessibility, safety, equity, person-centeredness, continuity, and efficiency. Findings highlight the importance of integrated care models, continuity of care, and alignment between purchasing strategies and health system building blocks. While no single purchasing approach fits all contexts, carefully designed arrangements—developed through participatory processes, piloting, and iterative learning—can support improvements in chronic care quality in LMICs.